Walking with your spine in mind444pdfrev3

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Walking with your Spine in Mind Improved body awareness for improved body health

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Walking With Your Spine in Mind Spine Class Table of Contents

Page

Introduction

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Chapter 1: How to use this book

18-23

Chapter 2: Build the foundation of your joint health with Neutral Postures

24-45

Time to focus on the function and awareness of the body parts The spine and the limbs Chapter 3: The Hip/Pelvis Three Dimensional Movement Exercise

47-57

Chapter 4: The Low Back Three Dimensional Movement Exercise

58-67

Chapter 5: The Rib Cage

68-75

Chapter 6: The Abdomen

76-81

Chapter 7: The Upper Back Three Dimensional Movement Exercise

82-91

Chapter 8: The Neck Three Dimensional Movement Exercise

92-100

Chapter 9: The Shoulder Three Dimensional Movement Exercise

Chapter 10: Rest of Upper Limb Three Dimensional Movement Exercise

101-113

114-120

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Chapter 11: Squats to Include Knee and Pelvis

121-137

Chapter 12: Foot / Ankle Three Dimensional Movement Exercise

138-148

Chapter 13: Lower Limb Three Dimensional functional stretching integrating Three Dimensional Spinal Movements

149-163

Now it’s time to get the spine working with the limbs and the limbs working with the spine Chapter 14: Whole Body Integration Exercise

165-171

Chapter 15: A review with a guide to whole body three-dimensional self-assessment 172-175 Chapter 16: Brushing your teeth for your spine

176-179

Chapter 17: Walking and the Five Way Reach

181-191

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Introduction I have been a chiropractor for nineteen years. I was drawn to this profession because of the relief chiropractic gave me as a student athlete. I loved how I felt when I was at the top of my game and I hated how I felt when physical injury kept me from playing at my best. Chiropractic kept me in the game until I could no longer ignore the limitations my injuries had brought about in my performance as a member of a team.

As a chiropractor I resist treating people in a way that makes them believe that chiropractic is a miracle solution for whatever ails them. It isn’t. The beauty of chiropractic in general is that people come to it first because something doesn’t feel right in their body and then, because they find relief they can start a process of gaining a much greater understanding of the body. They want to be helped and often a chiropractor is able to help, and when the Chiropractor educates them on how to take care of the body they can unleash the potential that the body has to heal itself and perform much more efficiently and effectively.

Some chiropractors like to adjust really aggressively and give the patient a huge impactful result. This is a problem if they do not help the patient understand what they have done or why they have done what they have done. As a result many patients treat chiropractic like its magic. “Nothing else has worked and then ‘boom’ he cracked me and it worked.” So because chiropractic treatments feel so good they keep coming back for the crack that makes the discomfort go away. There is a potential here to treat chiropractic like a pill for symptom relief only and miss the hidden potential that chiropractic offers for better understanding. It takes effort by both the chiropractor and the patient to use their work together as an opportunity for education and retraining. My hope is that this book will help provide such an opportunity.

As a chiropractor I work to help my patients stay in their “game” as long as possible, but I also work to help them understand what they can do to make the adjustments more 6 6

long lasting. I came to this way of working with patients by dealing with my own injuries.

Chiropractic kept me on the playing field, but it did not provide a long-term solution to the problems that kept me coming back to the chiropractic office. I had to learn those self-help techniques on my own. Chiropractic was vital for me to overcome my mechanical problems, but it was not a permanent fix that could take away the stress all my daily activities put on my body. Before I could get permanent relief for what ailed me I had to become aware of what I was doing in my daily activities that made it necessary for me to return again and again to the chiropractor. I find, as a Chiropractor, the best way I can help patients is to: first be the catalyst to help them feel better through the adjustments I make to their body; then second to help them become more aware of ways they can take control of rebuilding their physical health and then proactively progress toward optimal health by practicing how to move in three-dimensional balance. Don’t just feel good, take advantage of it by learning what has happened and what you can do to help it not happen again.

This book is about the techniques I have developed to help my patients and students identify and overcome the debilitating patterns they have built up in their own daily activities. I offer them to you in the hope that you will use them to realign and keep your body in the very best working condition.

Before sharing those techniques I’m going to tell you about my own experience and background as an athlete because by sharing them I hope to help you identify the many similarities between our experiences – not in the actual events but in the outcome of those experiences that have led you, as they led me, to painful and restrictive movements in my daily life. In the telling of this story I will also share the underlying concepts that support the exercises I will describe for you in this book.

My athletic career In high school and college I was determined to play football, hockey, and rugby as often as I could. I played or practiced these sports year round. Sometimes practices in one sport quickly followed a game in another. I played whether I was sore, hurt, or just plain tired. After injuries ended my college career I took up running and in time completed a marathon. Throughout all of these activities I ran hurt and I ran sore. It’s what my coaches and teammates expected of me. It’s what I expected of myself.

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My first injury, which I now recognize as a consequence of this, was to my right hip.

It came suddenly one game my junior year in high school on a play I had run hundreds of times before. I took the ball, turned up field and felt a pull in my hip. It wasn’t much, I kept going and played through the rest of the game, but this was the start of an injury that would be sore and bothersome for the rest of my playing career. I had probably set myself up for this football injury at hockey practice the day before when I had taken slap shot after slap shot from my left side - pulling my right hip flexor muscles many times in the process. I did not stretch afterwards because I didn’t have the time and, I certainly did not understand that muscle needs the increased circulation of stretching and movement after the kind of workout I was giving it that night. Instead, I went home to bed, and then the next day I sat around in class. My hip injury that night was set up by a perfect storm of mid-season overuse and mid-season lack of rest and mid-season just doing too much followed by too little and then expecting my body to do just what I had practiced endlessly to do as I turned up field.

That injury did not end my season or my ability to play, but it did set up all the aches and pains that were to follow. Since I was young and full of vigor I trained on without any real consequence, but then the following season when a player speared me on the inside of that thigh with his helmet the damage was compounded. That Friday night I should have been on TV as the impact of his helmet was such that I did a complete cartwheel before coming down on my right hip. I struggled to get up, did, and then limped off (how the fans cheered), rested a play or two and went back into the game.

Not long after my return to the game I was tackled again and as I hit the ground a second player slammed into my low back with his helmet. These joints and muscles immediately felt all jammed together. I could barely move. But being the seventeen-year old resilient athletic giant that I was, after limping off the field I went right back into the game. If you are reading this at home I’m sure you are standing just now to cheer for me.

You’ve been there in one sport or another and know that feeling of “Yeah, it hurts, but put me back in there.”

The next day was another story. My back had tightened up so much I could just about get out of bed. In school on Monday it was a real effort to stand up to walk to my next class. My coach suggested physical therapy. We followed that with massage, electrical 8 8

stimulation, and some stretches to do at home. These helped get me back on my feet and quickly became part of my life.

In time, when my improvement was not fast enough, the coach sent me to his chiropractor. Here my game and life’s course changed when the chiropractor adjusted my back. The crack I heard, and the immediate relief I felt, was life changing. I immediately recognized that I had not felt so loose and strong and relaxed in a number of years. In fact I felt so that I got up from the table and returned to practice (not recommended). I was ready to play.

Unfortunately I was not cured. I was merely adjusted. The pain in my back flared up again and again, and each time my chiropractor helped me, but he did not cure me.

Eventually, because the pain kept returning, my chiropractor took some x-rays and found that there was a lot of pressure on the joints of my spine from too much of a curve in my low back. He also suspected there was a stress fracture or something called spondylolisthesis. This injury is common in gymnasts, swimmers and football players because these sports require excessive low back extension that makes heavy use of the extensor muscles in the hips and low back, and the impact nature of these sports jams these muscles as well.

The issues in my right hip compounded my problems because it had never healed, and now my whole hip had to work harder to accomplish what I was asking it to do. Both sides of my hips had to compensate for the pull from the right side that caused a compression of the spine that further aggravated the spondylolisthesis.

So now I knew what the problem was and wanted to know how to get rid of the pain. None of the answers were easy or what I wanted to hear particularly as all I wanted was to play hard again as soon as possible. I know now it was not the physical therapist or chiropractor’s fault that the pain did not go away. It was my adherence to the code that taught me to play again as soon as I felt I could. Because I was young my body could handle this, but, what I didn’t understand, was that each time I went back to playing I compounded a destabilization in the joints that forced the surrounding muscles to become stronger in order to work around and through the hurt. Strong tissue can handle this for a while.

Unfortunately such compensations only put off the inevitable decline in ability that denies us the ability to participate at the high level we expect of ourselves.

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In time my back and hip injuries ended my university football career but only after I continued to play hard at the start of the week, was unable to stand straight or get out of bed or up from a chair in the middle of the week, missed a game here and there, and then went at it hard whenever I could. At the end of my sophomore year in college I gave up full contact sports.

However, as an athlete I was not finished. Because I loved the challenge of being in top physical form and the rush of feeling good after I exercised I took up jogging. By the time I was thirty-two I had run my first marathon. That was a great experience but my hip and low back were still a problem. Chiropractic manipulations, massage, energy work, and now and then acupuncture had helped me get in shape to run that marathon, but I wasn’t healed, I was merely coping and doing what I could to stay active.

Fortunately I had become aware enough to recognize something was not right in the way I was moving. One afternoon while running sprints with friends as I ran down the track I became aware that my right leg actually felt shorter than the left. Worse still, even though I wanted to compete with my friends all I could notice was that I was doing more with one side than the other.

After that I paid attention to what was going on when I was walking and running. I immediately understood that I was indeed favoring one leg over the other. As a chiropractor I knew that if I did not correct that imbalance I would go limping into middle age and in due course I would slouch and shuffle into old age. I became determined to figure out why I was caught in this cycle of decreasing mobility.

I also knew and taught my patients the details of good posture – standing, sitting, and lying down. But because these positions are static we pay little attention to correcting them even though there are many long-term benefits to correcting them. Changes in these postures teach us how to avoid additional pain by putting less stress on these body parts we hold in one position for long periods of time.

I was coming to realize that everything I did as a young man had been geared to go the way I wanted my body to go. My body had found ways to go along with what I put it through by following the path of least resistance and building compensations that allowed other parts to take up what the injured parts could no longer do. While we are still functioning at a high level compensations allow us to do this. Unfortunately compensations 10 10

are temporary, and I had reached that point in my own life where speed, power, and high performance were slipping away.

More important was my growing awareness that physical stress in parts of the body can be undone with movement. This became particularly clear to me at a chiropractic seminar called “The Body Force Transmission”. The presenter explained how all the body’s joints work together through its slings of muscles, tendons, and fascia to wind up and spring back transferring energy from one set of muscles to another to create efficient movement. As interconnected slings they transfer the force of impact in physical movement between themselves so that no one part of the body bears the brunt of all that impact and movement. It became clear to me that if I was limping on one side of my body I was limping because I was asking one side to do more work than the other. This imbalance – in my case caused because I had never fully recovered from my first injuries – was creating a strain in the muscles and tendons, and fascia on the uninjured side. I was compensating for the hurt by limping.

At another seminar I became more aware of how the spine is connected to these slings of muscles and tendons. The “spinal engine,” as the presenter called it, is flexible because it is segmented, and its ability to move is meant to wind up and spring back as part of the process of forward movement. When used as designed the spine is a powerful tool for efficient movement. This presenter discussed a study in which the researcher had studied how amputees relearned to walk. What he had discovered was that when they make full use of their core muscles to move the spine through the counter rotation of the pelvis and shoulders the relearning is much more quick and efficient. This might sound obvious once you read it but we don’t think about these details as we walk or limp or bend over. We just do them because that seems to be the way our body is moving. We are not aware of the specific movements of the individual parts of the spine and the limbs and how they interact. Nor are we aware of how subtle changes in our position and movements can create such dramatic effects as a limp or a stoop.

Learning about the spinal engine fit right into what I had learned about the interaction of all the muscles as part of efficient movement. Both ideas worked well with the concept that the body winds up and springs back to absorb and transfer as well as conserve energy. This system is so efficient it can use the force of our body weight 11 11

impacting the ground with every stride and turn it into force that drives the body forward.

This led me to consider how I might apply these ideas about movement to myself and then use what I learned for my patients.

Knowing what I wanted to accomplish was the first step but getting there was another. At the track I tried to walk more upright and to use my spine as a part of my movement. I modeled my movement on Michael Johnson and Jeremy Werner whose powerful running at the Olympics had been so inspiring. Each ran with their shoulders back and developed a lot of their power from their upper bodies. Their running was very efficient. They took advantage of power being generated from the spine more than other athletes that I saw.

Taking them as my model I began using my arms much more when I ran, and as my awareness and control grew I started initiating that movement from my shoulders, then my spine, and finally my core. As I included each part I became much more aware of how each part of that chain is necessary to create the kind of three-dimensional movement I was searching for.

About the same time as I was learning and practicing these movements in my upper body I was coming to understand much more about the mechanics of the foot. I knew from my own foot and leg problems - fallen arches, plantar fasciitis, shin splints, heel, and issues in my patellar tendon that I had not taken very good care of my feet. When I thought about how I was attempting to move more efficiently I realized that certainly the foot is integral to all of our movement. As I looked at its ability to absorb shock when we walk or run, jump or climb, stretch or stand I began to understand that like the rest of the body the foot is integrally connected to the whole process of forward movement. The foot is as flexible as the spine. It works from the back to the front and from outward to inward. As it absorbs the impact of walking and running it rolls forward from the heel and across the toes to spring back. It has the same wind up and spring back mechanisms as the spinal engine.

I recognized pretty quickly that when I stood and curled my toes up and shifted the majority of my body weight back on to my heels that the arch of my foot came back. I threw away my arch supports and have not needed them since. Then I began to run in an upright position, landing on my heel instead of my toes and I felt how my feet became a part of the stride as it rolled to the outer edge and transferred the weight across the toes to power the 12 12

lift off of the foot. I learned that landing on my heel as I ran or walked had no impact on the heel because it is designed to take that impact by rolling forward with the foot and then back again. Of course, this impact is lessened by the position and movement of the rest of the body. For those of you who are afraid of landing on the heel this is the missing component, you have to understand that you are only touching for a millisecond and rolling, you are not impacting.

When I came to study Gary Grey, a physical therapist out of Michigan, I found a language to use to express what I was learning at the track. Grey described our bodies as being designed to move in three dimensions. He stressed that movement in our bodies happens in three dimensions and planes of movement. He called the three dimensions of our bodies “planes�. Each plane is divided into two parts. The transverse plane divides the body into its top and bottom halves. The frontal plane is comprised of the front and back halves, and the sagittal plane divides the body into its right and left halves (See figure below.).

Right/Left

Top/Bottom

Front/Back

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Since our bodies are built to move in each of these three planes, movement occurs in three dimensions as well. All of our movements through and into each half of these planes occur at a specific joint or part of the body built to create that movement.

The kinds of movement in three dimensional planes are: 1. Bending forward (flexion) and backward (extension).

2. Bending to the side - right lateral flexion and left lateral flexion as well as abduction (moving your arm up and away from the midline for instance) and abduction toward the midline.

3. Rotation - right and left or internal toward the midline of rotation.

Understanding the dimensions our body moves through helped me lay the foundation for understanding how physical performance ought to happen. I came to understand that when movement does not proceed according to these principles pain and injury are compounded. Each of the parts of this three-dimensional body is designed to move freely in three-dimensional space. Each part winds up and springs back. There is energy in this if used correctly and there is also resistance if it is used incorrectly. When this resistance goes on for long periods of time wear and tear follows.

In time, after working out exercises and routines that helped me realign my own body, I shared the exercises and ideas with my patients and students at my community gym in a program called “The Spine Class.� In this class we isolate every area of the spine and core to move them through the three dimensions in order to become aware of how the whole works together. We begin by learning about 3-D movement in the three planes of the body and then apply that to neutral balanced positions of individual body parts. Next we integrate the body positions together with movement that is directly related to the walking cycle. Because the spine is the engine that drives the limbs we focus on the role of the limbs in steering and balancing as well as accelerating and decelerating. Students learn that when the walking cycle is initiated from the core, movement is efficient and effective. Ultimately we take the class out to the track where we put the isolated movements into practice by learning to walk in three dimensions. The result for those who practice the techniques of

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such walking and running is a side-to-side symmetry that provides a great reduction of physical aches and pains.

All of the exercises in the Spine Class and in this book are designed to build an increased awareness of how to use the core more efficiently. This core is made of the diaphragm on top, the abdominal muscles on the front and sides, the spine and paraspinal muscles in the back, and the pelvis floor muscles at the bottom. The core should not be thought of as a solid block of tissue that is separate from the rest of the body. Instead it should be seen as the inter-connected source of movement, control, and stability.

This book follows the exercises and conversations that are a part of The Spine Class.

The exercises and information it contains are intended to help you build an understanding and a fitness that will allow you to build your walking and running in a coordinated and balanced three dimensional way. As part of your fitness program it will lead to a life-long balance in your use of your muscles and tendons.

These exercises are an invitation to slow down and listen to what your body is telling you. If you are ready to listen you have the potential to unwind it, understand your compensations, and dodge the bullet of injury and pain for good.

We have amazing bodies, and, if we pay attention and start taking care of them we can live in full physical health for a long time. Chiropractic may be a part of it because if you are reading this book you are probably already asymmetrical in the way that you move – in other words you have some kind of joint restriction that is causing you to search for relief from some discomfort and pain. Like it, love it, or hate it, you need help to get rid of the pain that such joint restriction causes. Chiropractic can help with that, but once the joint is moving you must take care to learn how to move in a symmetrical, joint restriction free, fashion.

When you begin using your body in its full three-dimensional construction you will be using all the parts of your body in the way they are designed. The owner’s manual for your body, if there was such a thing, is very clear in its principles that all the parts must work together in order for the body to stay strong, healthy, and effective. You can’t just strengthen one area at the expense of the others. One joint affects the next, and one muscle affects the next. The childhood song, “Do the Hokey-Pokey,” had a good deal of wisdom in it.

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The hipbone is connected to the thigh bone; the thigh bone is connected … and so on. Our bodies are a system. They are not just parts working together.

So this book is a combination of education and exercise. The education is to build your awareness of how the body works so that you can know your body in a way that will make you aware of the balance that comes from symmetrical movement. As you become more aware of this balance you will readily become aware of when you are out of balance.

The awareness building and the exercises I suggest are designed to educate you on how it all works together. The value of this book is not going to be for the casual user, or for someone who wants an enduring miracle. It’s going to be for someone who is committed to the process. It might take four to six months to be symmetrically aligned, but certainly within two months the reader and practitioner of the exercises will feel a difference that will last for the rest of their life.

Messages I want to convey strongly Your Hidden potential: Walk with your spine in mind. With our daily activities we need to come back to three-dimensional symmetry to avoid the accumulation of compensations that come to impede movement. If we are going to perform at a high level for a long time we need learn how to keep our bodies in a low stress neutral position. We need to learn what these low stress neutral positions feel like and then practice them frequently enough for the nervous system to learn the positions so well that they become automatic.

The body is amazing. It has many hidden mechanical advantages that if used can reduce stress and improve performance. However, if you are unaware of these mechanical advantages it will take time to build your body’s ability to take advantage of them. The mechanical advantages I’m referring to involve improving your ability to reach out in each of the three dimensions. Learning to do this will allow you to take advantage of the elasticity of the soft tissues so the levers that our bones and joints create can work in the supportive and efficient way they are designed to move. The process involved in learning about and using these mechanical advantages is non-invasive and costs nothing more than your time. Once learned, they can become a part of the rest of your life. These techniques will take away the compensations that create aches and pains, while increasing your longevity and quality of life. Some improvement will happen almost immediately but others 16 16

will require consistent practice. However, be assured that if you are aware of the process your gains are almost limitless.

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Chapter 1 How to use all the parts of each chapter

In each chapter there are many layers to digest. Some of that information is designed to sell you on committing to the work involved in learning these new routines.

Other information is about the anatomy of your body. It is meant to help you understand how your body is designed to function so that you can see the value of the exercises that are included for each of the body parts under discussion. Finally there are exercises whose purpose is purely practical. These are designed to help you immediately. Each can stand on its own as an exercise. But it is only in the correct practice of all these exercises that you will transform your awareness of how your body works. So I suggest that you: 1. Skim the information to get an idea of what is contained in the chapter. Once you have that overview and understand what information there is to come back to move on to reading closely the practical exercises.

2. Read each practical exercises several times to grasp how to execute it. I ask you to do this because I know each of us reads, sees, and comprehends things differently. So reading each exercise several times will insure that you understand based on your own ability to understand. Please resist the urge to say, “This takes too much time and effort.

Show me a video.� Even with small group classes and one on one demonstration it takes time for class members and patients to digest the correct way to do these exercises. It is a process to learn a new exercise properly and the more effort you put into the process at every level the more you will get out of the exercise.

3. Practice the exercise several times briefly.

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4. Review the awareness section and how the body works together.

5. Practice the exercise again with increased awareness and understanding so you can eventually create your own language to what you are feeling.

6. At this point it may well be worth your while in each chapter to go back to read the descriptions about the physical construction of the body part we are working with.

Reading this section at this point of your learning will prepare you for using the Awareness Builders I’ve included in each chapter. These are designed to help build your awareness of the improvements you should be noticing as you practice these exercises. As your awareness grows you should be increasingly able to self-assess not only the improvements but also the imbalances that remain. By being more aware of how you ought to be moving and when you are not moving in the fashion you are designed to move you can learn to make the subtle adjustments that will realign the imbalances that are causing you discomfort or pain. What follows is an introduction to these awareness builders.

About the “Awareness Builders” at the end of each chapter These Awareness Builders are included in end of each chapter so that you have some clues about the changes and awareness about the growing balance in three dimensions that will come about as a result of the work you do to learn and then incorporate them in to your routines. When you know what to look for in your physical alignment you will learn how to challenge yourself to achieve and maintain that alignment for the health of your joints and the soft tissues that support them.

Our body directs us how to move through our senses and the compensation patterns we have added to the way we move. By becoming more aware of how the body is supposed to feel and work we will be less likely to be changed by the kinds of limiting influences that come to us from repetitions of patterns in our day to day movements.

Sitting in meetings for eight hours a day fatigues certain muscles and locks up certain joints. Such restrictions will affect how we move and by causing the soft tissue to tighten to the point of rigidity. This is how repetitive strain injuries happen. Our bodies will find ways to adapt to whatever we give them.

The problem with our bodies’ reactionary approach is that it is temporary focused.

On its own our body does not have a plan to deal with future changes. It just continues to 19 19

grow toward whatever stress it is given, responding and adapting to changes in the environment by doing what we unconsciously ask it to accomplish.

If you are aware of how the body is supposed to feel and work you can control this evolution toward compensation due to pain avoidance, discomfort or awkwardness.

Awareness of how individual parts work together can give you the tools to develop greater control over managing the reverse of this process which is to remain in a stable, three dimensionally aligned body. Becoming aware of how you are designed to move and then practicing movements to move in such a fashion will soon become a routine that feels good and far more physically healthy.

So, these “Awareness Builders� are designed to make you aware of the kinds of changes you will experience as you proceed to practice each of the exercises. In time these awareness builders will help you do a bit of self-analysis about the effectiveness of your practice. Enjoy and learn.

Understanding the wind up and spring back of soft tissues portions of each chapter In each chapter I’ve also included information about the wind up and spring back of the soft tissues that surround the body part the exercises are focused on. These are included as a bit of a sales promotion. As you become aware of how soft tissues like muscles, tendons and ligaments are designed to work I hope you will understand the value of committing to doing these exercises.

So a bit of an overview of what happens in the soft tissues when they are used as they are designed. Stretching these soft tissues takes an input of energy that can be stored to a degree in the elastic fibers that are connected to these soft tissues. That energy ought to be returned as part of the movement when the tissues relax. When these tissues are used according to design energy is stored and conserved making more movement possible without costing the body additional energy output.

For example, pulling your arm back requires a contraction of the back portion of your shoulder muscles. That costs your body energy because as you pull your arm back, the tissue winds up (stretches) the elastic soft tissues of the muscles, tendons, and ligaments on the front of the shoulder. This contraction stores energy. When you relax that shoulder,

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the arm swings back and unwinds those elastic tissues. Because of the energy that was stored on the backward contraction when the arm swings forward less energy was used.

The way the body works is that in the pulling back and springing forward there is energy held and released. Energy is gained and let go. Such a system is far more effective than if each portion of the movement – pull back and release – was accomplished with a contraction in both directions. Because the muscles are already moving, momentum becomes the extra energy you don’t have to use to get things moving again.

When we walk without swinging our arms it takes more energy to keep moving because we are not making use of the wind up and spring back that is available in our arms and shoulders. By walking without swinging our arms less momentum is created and more energy is required with each stride to move the legs. The stress that moving in such a way creates leads to repetitive strain injuries because energy is jammed up into the muscles without releasing it.

The wind up and spring back in our soft tissues is enhanced by the alternating high and low mobility of adjacent joints in which the low mobility joints act as pivot points that allow the more highly mobile areas even greater exertion. It’s the stability of these joints that create the leverage for the more mobile high tissues. If the body did not possess this alternating back and forth high to low mobility in adjacent joints we would not be very mechanically effective, and as a whole we would be very limited on how many thing we could do with strength, speed, power and endurance.

The alternating high and low mobility of adjacent joints affect the function of the strong tendons and fascia to create a whipping action as the tissues recoil from their hyper stretched position into their neutral position.

One additional point about these soft tissue interactions is that these exercises will stretch these soft tissues and activate the nerves and muscle so that more of the muscle fibers will become involved in the contraction. These exercises will thus make your movement more powerful, take less effort, and save you energy as you improve your performance and create more endurance.

So look for the soft tissue details in each chapter in order to understand the possibility and potential that complete use of these soft tissues will provide you.

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Where are we going with these exercises? Walking…

All these exercises lay the foundation for a more effective walking cycle. In the last chapter we will thoroughly discuss the walking cycle and show you how it can benefit the whole body. The walking cycle can effectively take the place of all the exercises you will work on in this book. However, without these exercises as the foundation for that last chapter chances are you will only take your current imbalances and compensations into the walking cycle. It is very important to build the final chapter’s work on a firm foundation of a body that is practiced into three-dimensional alignment. Once you have developed your awareness, strength, flexibility and control that these exercises create you will be ready for that complete cycle. So that you understand why we are doing all this work to get to what you are already doing consider the following: 1. When we walk we are moving forward more than 99% of the time. When we walk out of three-dimensional alignment we are flexed slightly forward and have to compensate for this.

2. We are side dominant with our limb movements. Therefore one side is stronger and more flexible than the other and the spine and trunk have to compensate for this.

3. We walk with our legs with little use of our arms. Therefore our lower body and its connection to the spine and core have to work harder. We have to compensate for that.

4. Because we are unaware of how our spine is meant to contribute to walking it is underutilized and becomes weak and dysfunctional. We have to compensate for this.

5. We are unaware of how to effectively connect our limb movements to our core and control our movements from the core. Therefore our whole body movement is less effective and the connections of the limbs to the trunk are over stressed. We have to compensate for this.

6. Finally, we typically manage the movement of acceleration, deceleration, and balance with our legs. The upper body, trunk and arms come along for the ride. This is not how we are designed to move. The upper body is meant to be an equal contributor in this movement. If it wasn’t then all the joints of the spine, upper limbs, and the inter connections of the soft tissues, muscles, tendons, and fascia would have no purpose or function. They are there for a reason. The exercises in this book are designed to help you 22 22

establish the physical skills to allow you to walk correctly and efficiently so that you make full use of the whole of your body and not just the parts that you have grown used to using.

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Chapter 2: Build the foundation of your joint health with Neutral Postures

Neutral Posture Neutral postures help us manage the health of our joints so it is important to become aware of when the body is most relaxed and at its lowest point of stress. Such neutral positions are positions of balance. These also are the point that is most mechanically effective to begin movement because from them the body can absorb the greatest shock or transfer energy most efficiently. Neutral postures can be achieved then the body is centered in each of its three dimensions - side to side, top to bottom, and front to back.

This chapter is about how to achieve neutrality when standing, sitting, and lying down. Such neutral postures can be either stationary or static. Stationary postures are selfexplanatory in that they involve no movement, but because they are often held for long periods of time if they are not done in three-dimensional balance aches and pains will develop. That’s because even in neutral these muscles are being used. Such stationary postures create a lot of feedback for the nervous system that establishes patterns that will spill over into other postures.

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Neutral postures can also be dynamic especially when we walk or lift. Dynamic postures demand our awareness and attention because they involve shock absorption and energy transfer from one body part to another. We can achieve neutrality in our movement by moving in a way that demands as little resistance as possible from our joints and muscles. The body’s position sense receptors constantly give the brain feedback on where all its parts are in relation to all the others. It tells the brain how much pressure is on each part largely through relaying information about how much stretch each part is experiencing. When combined with the sensory feedback that we develop from our eyes and our ears our brain is able to control and coordinate a dynamic counterbalancing of our body weight as we move about. This counterbalancing helps us avoid falling.

The brain learned this counterbalancing when we were infants as we went from lying to sitting, to standing, squatting, crawling, and finally to walking and running. Each new stage was a thrill for our parents and growth for our brain’s development. Each new movement increased awareness in our nervous system, and we continue to build such sensory awareness anytime we learn a new physical skill Each new skill whether it’s throwing a ball, dancing with a partner, or walking on a beam demands that we refine the details of the movement and integrate it into what we already do.

Along the way we sometimes fall down or twist in a way that hurts. When that happens we experience pain and our brain learns to avoid the pain as a reflex action that keeps us from further harm and free of pain. Large stressors like burns, cuts and contusions can cause us move in new ways just to minimize the pain that we feel from them. But slouching or walking with our foot turned out will also build micro-sensory protection against the pain these movements create. These micro-sensory solutions can keep us from pain for many years as we adapt to them. But when the body is over taxed and can no longer compensate for what has happened it will put a halt to hiding that accumulated pain. This often happens when we take up some new exercise program that demands moving in a way that is unfamiliar. Then getting out of the couch, or bending in the shower, or catching ourselves from a small slip will bring all the micro stressors to our attention in a macro way.

When it comes to maximizing efficiency to improve the way we move or to prevent some pain or injury we have to be conscious of what has gone before and then work to 25 25

undo the accumulated stresses of the way we have moved. This book is about helping you become more conscious of the details of how your body moves. It is about helping you to realize the importance of moving in ways that are balanced and proportional to the whole of your body and not just to the part that might be hurting. Understanding neutral postures is the beginning of building an awareness of how to get out of neutral and into dynamic balanced movement. .

Stationary Neutral Postures Standing posture We begin with the standing posture because it is the most functional position for learning about proper body alignment. A functional position in this case is one we are designed to do for long periods of time. In a functional position there is a minimal compressive load on the joints and there is very little muscular effort needed to maintain this position for long periods. In a functional movement the muscles, nerves, and joints all work together to provide the easiest movement without creating wear and tear on them. Walking in three dimensions symmetrically is functional.

However walking or carrying a backpack over one shoulder is not a functional movement.

We can learn to walk carrying a backpack over one shoulder and our bodies will go along with it, but it is not functional due to the asymmetry that the backpack causes. The backpack creates an asymmetry that throws the body into an imbalance and increases an uneven load on the joints, muscles and nerves. Long periods of walking in this way will create fatigue and over time wear and tear. Most sports fall into this non-functional definition and for that reason most sports require cross training to avoid repetitive strain injuries.

We are designed to stand. It is a prelude to movement. Because we initiate our movement, particularly walking, from a neutral posture we must start our awareness building there. Poor posture, and physical aches and pains often come out of what we are doing prior to moving. If we slouch or lean forward when we stand we will walk with a slouch or a forward lean because our muscles and nerves have been entrained to the slouch and lean. If we sit for three hours in a forward lean when we stand up we will lean forward.

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So learning to stand in a neutral posture prior to movement is the best way to walk in an upright, three-dimensionally correct alignment. It’s also the best place to begin our awareness building of correct alignment. Standing in the way I will outline below will help you feel your stomach turn on and your back relax because their low back and buttocks will no longer be involved in the strain of holding the entire body from falling forward. It will also help you to begin each movement whether it is walking, running, or lifting in a position that will allow you to take advantage of your full physical potential.

Three-dimensional neutral standing includes establishing balance front to back, side-toside, and top to bottom. That means the shoulders should be aligned equally above the hips, with the buttocks relaxed and the stomach pulled up a bit. Your head should be centered between the shoulders. Your knees and hips should be straight - both front to back and side-to-side – and your hands should face inward or slightly forward. Doing this retracts your shoulders into a neutral position.

To bring the body to neutral stand with your: 

Feet straight



Toes of each foot up equally - big and little ones especially*



Body weight shifted back so it is over the heels and balls of feet



Knees, hips and low back straightened



Back and buttocks relaxed*



Abdominals reflexively engaged



Inner thigh engaged while relaxing the outer thigh*



Shoulder blades pulled back and down without engaging low back*



Chin tucked straight back*



Jaw held parallel to ground* * means very challenging and pay close attention if this isn’t challenging you may be doing it wrong

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In general poor standing posture is out of balance from the neutral standing positions just described. Poor standing posture is over flexed in the ankles, knees, hips, shoulders, and spine. In a poor standing posture the dominant side will typically flex more than the non-dominant side, and often this will include a bending to one side and an outward rotation of the other. The first set of pictures shown below illustrates a poor standing posture. Chances are standing in this way will feel very familiar. They will also feel comfortable not because they are correct but because they are familiar.

Poor posture - This is exaggarated for most of us but the components are the same and the exaggeration helps you to see the compensation

Weight forward.

Toes gripping ground Weight on arch Feet turned out Knees and hips bent Back/butt over contract Stomach/inner thigh off Spinal curves increased Arms rotated forward Shoulders forward Head forward Straight neck curve Chin forward

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The next series of photos show a front and side view of the neutral standing position. Notice my feet are pointed straight ahead and that I appear to be tilted back a bit.

That’s because I am standing on my heels, and what you can’t see is that I’ve curled my toes up. I’m sure that it sounds uncomfortable and awkward to you, but it isn’t. It’s the most natural and overall correct way for you to be standing. I assure you that even though it may look awkward it is indeed comfortable and with practice it becomes both mentally and physically easy.

Shifting to correct neutral posture in 3-Dimensions Standing upright posture side and front view - Seems exaggerated but with practice becomes comfortable.

Weight neutral Toes up Weight off arch Feet straight and shoulder width apart Knees and hips straight Back/butt relaxed Stomach/inner thigh engaged Spinal curves neutral Arms rotated back and held in neutral Shoulders back and neutral Head neutral Neutral neck curve Chin tucked straight back with jaw parallel to ground

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So now I want you to practice the neutral standing posture. Stand about six to twelve inches away from a wall with your back facing it. Now curl your toes up and rock your whole body backwards as if there was a board behind you. Now let your abdominals reflexively turn on so you can resist the feeling of falling back. Do not control this feeling by contracting your with low back and buttocks so that your back arches. Keep your weight on your heels (not on your toes) and let your back and buttocks relax as you straighten your knees, hips, pelvis and spinal curves. Try to control your body in this new straightened position with your upper and lower abdominals, as well as your inner thigh muscles for as long as you can. This will help you gain awareness and control over the neutral standing position.

Back to complete the neutral standing posture.

Detailed shifting back to neutral standing posture from a slightly forward compensated position.

When you begin practicing this neutral standing posture you may find it difficult to relax your back and buttocks. In fact you may find that they are sore and that is because they have been compensating for the forward lean of your posture for as long as you have been standing in the old way. Relaxing them may hurt at first because of the fatigue time has built into them. Relaxing them in this new way will stretch muscles that have grown short. Shifting back onto the heels and balls of your feet will take away the reflex to contract these muscles that happens when you lean forward into a slouch.

This brief exercise will bring circulation back into this area, the pain will reduce, and you will improve in your ability to relax this area. Practice this neutral standing position each time you find yourself standing about whether it’s waiting in line, talking to a friend, 30 30

looking out the window – any and all the occasions when you are standing. The goal here is to make you familiar with and then comfortable with the neutral standing posture in order to make the new way of standing familiar and comfortable.

There is also this to be aware of – our shoes are built to tilt us forward. Worse still most of our shoes are constructed with heels that are higher than the toes so we tilt forward. Pity women in high heels! That forward tilt forces our body to almost immediately compensate forward by bending (flexing) and outwardly (externally) rotating. The back and buttock muscles then contract to reflexively stop you from falling forwards and the stomach shuts off. The pelvis tilts forward, the hip, knee and ankle flex/bend and the foot, leg, thigh and pelvis all turn outward to create a broader base of support. While the body is leaning forward, the spinal curves increase in the low back and upper back to continue the counter balance. The head comes forward and straightens the neck with a hyperextension in the upper and lower neck effectively locking it in a forward position. Lastly the shoulders elevate and come forward, protracting in response to the neck and upper back shifts. (This all happens reflexively or very quickly and without conscious control). So shoes and there repercussions are important to be aware of and correctively cross train for with neutral standing.

Neutral Sitting Posture A neutral sitting posture is much tougher to achieve than the neutral standing posture mainly because sitting puts us in a flexed position. As with the neutral standing posture when we sit we want to get the upper body aligned above the pelvis in a neutral, un-flexed position that eliminates a forward rounding of the shoulders and hyper-extension of the back. Slouching when we sit causes the lower half of our body to shift forward and puts us further out of alignment especially when we allow the legs to splay outward in rotation and abduction away from the body midline. Crossing your knees or ankles, or sitting with your knees spread apart outs pressure on the low back and buttocks by engaging those muscles reflexively. Sitting in the ways I’ve called attention to above are comfortable because they feel good and are familiar, but they do not allow the neutral alignment you are trying to achieve.

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When you round forward you are in flexion and no longer aligned above your hips. With your shoulders rounded forward, in order to look up your head and neck must be raised up. Think about how you feel when sitting with your shoulders rounded forward. I’m sure you are aware of the strain that comes from having to hold your head and neck up in order to look at someone across the room. It’s a strain and it hurts. Sitting in a neutral posture in the way that I will describe will take care of that hurt.

The way that we sit is complicated by furniture we sit on complicates the challenge of sitting in a neutral position. Our couches are too soft. Kitchen and desk chairs are too rigid and non-conforming. Office chairs are very functional and can be adjusted for height, but in the work environment because we need to be forward in our seats to accomplish multiple tasks the back support in office chairs is mostly useless. The car seat that is designed for sitting in for long periods of time does not provide adequate support for our neck and low back. All of these sitting situations can be alleviated when you become more aware of how to sit in them in a neutral posture.

However the longer we sit the greater is the opportunity we will slip out of the neutral position and into the more familiar slump. The solution is to get up and move about whenever you have to sit for long periods. Having several neutral aligning exercises to complete once an hour is an excellent way to return to a neutral posture. I’ll share more of those later.

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Sitting Posture Transitions – The bad

Forward flexed

Back and buttock working

Low back rounded

Feet turned out

Rounded upper back

Knees outside ankles

Shoulders rounded

Shoulders rounded

Head forward

Head forward

I recommend that when you are watching television, rather than sitting or slouching on a couch, lie on the floor with your legs up on a footstool. A foam wedge or rolled up towel in the middle of your low back will provide additional support for your back when you are lying on the floor in this fashion. We really should be looking straight at the screen and not at an angle.

Whether you are sitting or lying on the floor try to look straight at the monitor. Do not sit with your head turned to one side in order to look at the screen.

So here’s how to sit in a neutral posture in order to bring your joints and muscles into a neutral low stress position. First bring your hips back into a chair as far as you can.

They should fit snug up against the seat back. Now place your feet so they are pointing straight ahead. They should be about shoulder width apart. Bring your knees inside your ankles. Now tighten your inner thighs while attempting to relax your outer thighs and buttocks. Draw your navel in toward your spine. Pull your shoulder blades down towards your hips and then back. Pull the lower front ribs down toward the front of the pelvis. Bring your head and neck to the center of your body holding your chin parallel to the floor.

Finally, rotate your hands so that the palms face upward.

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Sitting Posture Transitions – The good [diagram] Chin tuck straight back Shoulder blades back and down

Ribs down to pelvis Navel to spine Knees inside the ankles Feet straight

Sitting Posture Transitions – The Good

Upright neutral

Inner thigh and abdominals working

Low back curve established

Feet straight

Neutral upper back

Knees inside ankles

Shoulders back and down

Shoulders back and down

Ribs down to pelvis

Ribs down to pelvis

Chin tucked straight back

Chin tucked straight back

These steps will put you into a comfortable neutral position that will allow you to easily move out of this position without pulling muscles that have not been engaged but may have been overstretched during the sitting process. They provide greater support for the spine and the pelvis and connect the shoulders to the upper abdominals because you have engaged your stomach by

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drawing your navel in toward your spine and tightened your pelvic floor by bringing your trunk further back into the seat.

You can help to support the lower back as well as the pelvis, neck and upper back by placing a small rolled towel or foam noodle just above the iliac crest (top part of the bony pelvis).

This support should only be light and specific rather than aggressive and broad. A rolled up towel at that specific level of the top of the pelvis is far more effective than a thick curved pillow that covers the whole low back.

As you follow these steps you might notice one or more changes in the way you feel sitting in the chair or on a couch. You might feel less tense, more upright, more relaxed, and perhaps even more aware of all the parts of your body that are engaged in achieving this neutral posture.

Achieving a neutral posture when sitting initially will take a lot of attention and awareness. The best way to help the nervous system make the change from the old forward compensated position is to practice this kind of sitting briefly and frequently. You don’t have to make this change all at once, but done briefly and frequently you will become aware of the difference in alignment. As you feel the difference you will find yourself wanting to sit in a neutrally aligned position more often and for longer times. Give yourself two weeks of frequent focus to learn and become comfortable with the process.

Let me offer one further note about the value of getting used to sitting in a neutral position.

Quite often patients will come to me with complaints of low or upper back pain that might manifest itself after some new activity such as working in the garden at the start of spring or paddling a canoe. The pain may manifest itself as spasms. Pain such as this comes about because the new activity involved a forward flexion that had no support for the lower back. Because we are bent over or sitting with a rounded and unsupported back, possibly with our legs apart, that change of activity and new movement manifests itself as low and upper back pain. Sitting in a slumped position puts increased strain on our spine because we have overstretched the unused muscles that are close to the spine in our hips or shoulders. Fatigue may lead to reflex muscle spasms that pinch joints and put pressure on discs. After this kind of activity most of us treat ourselves to slumping into a couch or cozy chair. Then, when we stand up, the pain will set in.

My recommendation is that after some new or strenuous activity the best next step is to sit in a neutral posture as I described above. Even though the old posture of slumping into a couch

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feels great because it fits our muscle memory, remember that a neutral position, even if you are fatigued and hurting, is best for allowing the muscles of the low and upper back to disengage and renew themselves after strenuous or infrequent new activities.

Neutral Lying Posture Because we spend so much time lying down it is important to realize that even here we must be aware of our posture. Our muscles, tendons, joints, and ligaments can feel fine when we are lying down but we can experience a significant amount of pain when we move to get out of that position. Whether you are younger or older mornings, particularly as we get older, can be filled with aches and pains. That’s because all the muscles throughout our body have been held in one position for six, seven, eight, or more hours.

Imagine stretching your ankle by turning your foot on its side while you are standing on it.

You could hold that stretch comfortably for 10-20 seconds. It might feel awkward but you could do it. Now, if you held that same stretch for three to five minutes you would find it more than uncomfortable. Consider how that stretch would feel after six to eight hours! That’s what we are doing to our ligaments, muscles, tendons, and joints each night.

When a ligament is stretched or held for a greater than normal length of time, it creates structural deformations that take a while to undo. That’s why the aches and pains of early morning go away after we have been up awhile and given those ligaments the small and continuous ranges of motion that bring them back to normal circulation. Moving about allows the soft tissue to recover.

So when we are sleeping we have to be careful that we are not in a position that creates a stretch that is difficult to undo when we move about in the morning. This is particularly important when we have complicated the ability of our soft tissues to rest completely because we have done strenuous workouts or unusual activities around the house or yard. If we go to bed sore or aching and then lay in one position or multiple positions of stress for eight hours those aches and pains we went to bed with will be compounded. As we get older degenerative changes will also lead to further discomfort when we hold those tissues in one position for long periods of time.

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Let’s deal with the bad news first about the best way to sleep in a neutral and un-stressful position. If you are sleeping on your stomach be aware that this is the most harmful position in which to sleep. It is neither relaxed nor neutral. It puts a great deal of torque and stress on the muscles, tendons, and ligaments of the spine. In order to breathe in this position you must rotate your head and neck a full 90 degrees. This creates even more torque and tension on the neck and upper back.

As for those of you who just can’t get away from sleeping on your stomach here are some suggestions to help you get a good night’s sleep without waking up with a neck ache and all the other aches that go with sleeping on your stomach. The first step is to place two to three pillows under your waist and chest. Then support your head and neck with a pillow that leaves less than 90° of rotation in the neck. Now bend one knee to 90° and bend the same side arm up at 90°. Leave the opposite leg straight and bend the opposite arm down at 90° behind your body.

Stomach Lying Posture The Bad

The Good

Low back over extended

Low back supported closer to neutral

Both arms under head [left not seen]

Back arm straight behind front arm bent in front

Shoulders over extended

Shoulders in neutral

Head and neck over extended and over rotated

Head and neck closer to neutral, neck lightly supported

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Sleeping on your side is less stressful than sleeping on your stomach, but this creates side bending - rotational stress - on the joints of the shoulders and spine.

Depending on the pillow you are using your head will be either tilted up or down. Often, when we are sleeping on our side, we’re lying with our head up because of the lift of our shoulder. This puts most of the stress between the arm and shoulder blades even though we might be able to rotate enough to get the shoulder blade back on to the bed in a way that does not create a stretch between the arm and the shoulder blade. This still puts some torque on the upper back and lower back junction.

The other problem with lying on your side is that often one leg is bent beneath the other and this takes the pelvis out of its normal neutral position and creates a torque on the joints of the pelvis and the lower back. When you’re on your side your upper body – shoulders and spine rounds forward as well. You can get away with all this winding up for a long time. You can even get away with having one leg in front and one leg straight, and this increases the amount of torque, but when you’re injured lying in this fashion is going to increase the pain and tightness you feel later.

If you must lie on your side, place pillows between your knees so that your legs are parallel. This will take the torsion out of your pelvis and low back. Your knees should be bent at 120° angle. Lying in this way your head and neck should be centered between your shoulders with a pillow that provides support for your head in a way that leaves it in the middle of your shoulders. Pillows that leave your neck either above or below the natural line of the head and the neck will leave you sore and achy.

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Side Lying Posture The Bad

The Good

Top leg crossed over bottom leg

Top and bottom leg parallel

Low back torsion

Low back neutral

Shoulders rounded forward

Shoulders closer to neutral

Weight on bottom shoulder

Weight on shoulder blade not joint

Head and neck over supported and over rotated

Head and neck closer to neutral support

Sleeping on your back is the best way to achieve a neutral posture in bed. Sleeping in this way gives you the ability to put all the areas of your body - neck, shoulders, upper back, lower back, hips, knees and legs into a relaxed and neutral position.

Here are a few tips to make this position even more comfortable and effective. First place your arms at your side with your palms facing up so you can rotate your shoulder blades back and down to a neutral shoulder position. Before you lie down you might try squeezing your shoulder blades together. Then lie back on them to use your body weight to maintain the shoulders in that neutral position. At first you will feel a stretch in the front of your shoulders and they may creep forward, but gradually the more you do this the more this area will stretch out and the more comfortable you will become with your arms at your sides and palms facing up.

Because neck support should keep the neck in line with your upper back a pillow creates a problem with neutral alignment. The best way to achieve the additional support that is needed is to place a small rolled up towel about twice your hand thickness in the center of your neck. A lot of pillows out there have a curve that is designed to support the 39 39

head and neck by cupping around the neck. What the designer of the pillow is missing is that any support behind the head lifts the head forward in front of the upper back. It also straightens out the neck curve and thus counters the effect the supportive roll is designed to manage. In some cases such pillows may be okay, but the goal should be to undo the rigid compensation of a pillow and try to get to neural position a rolled up towel will promote.

Neutral head and neck support however means sleeping without head support with just a rolled up towel for light neck support. An intermediate strategy would be do the stretches that follow in the spine class and start with a few small folded towels behind the head and a rolled towel beneath the neck, then slowly and over time reduce the height of the towels behind the head.

With a good mattress you really have no need to do anything special for your back.

However, a soft mattress cradles you in a slouched position. This is not a great problem unless there is some secondary stressor. If your thigh muscles, your hip flexors, gluteal, or hamstrings are tight, these can exert a pull on your lower back through the night that can then give you low back stiffness in the morning. Putting two or three pillows under your bent knees will tilt the pelvis up and put your lower back curve in a neutral position.

If you’re changing from a side posture or a back posture getting used to a low back neutral position can be difficult and you will need several stretches to help your body become more resilient and adapted to sleeping on your back. It takes several weeks to make this change, but because it is so important to be sleeping in a less stressful, more neutral position, it is entirely worth the effort of changing the way that you sleep.

One such stretch is the overhead reach in which you bend side to side and rotate side to side. Extending your back as part of a squat is also great for increasing resiliency of the para-spinal muscles. Doing a side step with your leg turning one way and body rotating in the opposite direction is great for getting to the thigh and pelvis muscles. Some specific stretches for the thigh and pelvis muscles on a consistent basis can help you get to a point where you are not reliant on pillows under your knees to take pressure off your lower back.

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Back Lying Posture – The Bad

The Good

Legs turned out, low back curve increased

Legs straight, knees bent, low back curve neutral

Outer thigh, buttock and low back muscles engaged Outer thigh, buttock and low back muscles relaxed Arms and shoulders rotated forward

Arms and shoulders rotated back to neutral

Head over supported, neck curve straight

Head and neck curve in neutral with light neck support

Please understand that the lying positions I’ve recommended may be difficult to get used to. The transition to the neutral position can beat you up for a while so don’t evaluate whether a posture like lying on your back is good or bad for you right away. Give yourself some time to make the adjustment.

Awareness point of view



Lying flat on your back



Place a pillow under your knees to bring your torso to thigh angle of 120° to bring the pelvis and low back curve into neutral



Rather than a pillow place a rolled up towel under your neck to support the neck curve and leave your face parallel to the ceiling



Place your arms at your side with your palms facing up and your shoulders pulled back and down

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Awareness Builder for Stationary postures: Building your “body awareness” begins with the stationary postures. The following key points apply to each of the stationary postures and effect similar areas of the body even though we are talking about different postures.

•

Keeping your feet straight has the effect of aligning the joints of the lower limbs and

gives you a reference point by which to gage how equally you are using both sides of your body. When your feet are pointing straight ahead you should be aware of a symmetrical balance that eases the stress on the spine from below. This is true whether you sitting, standing, walking, squatting or lying down. It might feel different in each position but you should be aware that your lower back feels less stress.

•

Curling your toes upward has the effect of shifting your body back two or three

degrees and thus relaxes the back of your body while turning on the muscles in the front of the body. This contraction of the muscles in the front of your body will create a relaxing shift in your posture whether you are sitting, standing, lying, squatting, or walking.

•

By holding your feet shoulder width apart you keep the legs parallel and balance the

stress on the pelvis and spine from right to left. When you come to appreciate the differences and similarities of how this feels in the lower limbs and trunk in each of the postures you will become aware of the hidden holding patterns you’ve established in your nervous system. By being aware of them you will begin to release them through the symmetry of your movement.

•

When you learn to keep the knees slightly inside the ankles so that you feel the inner

thigh muscles engaged you will begin to feel how these muscles contribute to the control of the position of the foot, knee, hip, pelvis and low back. Your awareness will help you feel the symmetry of this position relative to the body’s midline.

•

Drawing the navel to the spine and relaxing the back and the buttocks keeps the

pelvis in a neutral position when the first two points are balanced from below. As you become aware of how this feels you will recognize that we almost always have an unbalanced control over the pelvis that puts more pressure on the hips and the spine.

Again this is true for all postures, but, as in the previous awareness builders, this may feel

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different in each position because of how gravity affects the body and creates changes in each of us.

•

Pulling the shoulders back while pulling the front of the ribs down to the front of the

pelvis helps bring the pelvis into neutral from above and the upper body back to a more neutral position over the pelvis to work the muscles that connect the shoulder girdle to the core. Putting the pelvis into a neutral position helps establish the low back curve which in turns supports the neutral position of the upper back and neck curve, it is all connected.

This is an easy one to become aware of particularly if you carry tension in your shoulders or sit or stand with them hunched upwards. The difference between the two is quickly recognizable when you release the shoulders down.

•

Tucking your chin straight back and holding it parallel to the floor helps bring the

upper body back on top of the pelvis and aligns the spinal curves from above. This should be done after all the other key alignments have been taken care of. If you feel a lot of resistance to this move please be aware that there are other adjustments that need to be made lower down in the body. When all the other points are aligned this alignment should make you feel aware of how good it feels to stand in such symmetry. It feels good – as if you are meant to be aligned in this way. Not only are the joints and muscles at a greater rest point the circulation and energy in your body flows much more easily.

•

Standing as if a string is coming out of the top of your head pulling you lengthwise

upwards should make you aware of how your core is engaged from above. You should be aware of how this causes a stretching and light contraction of abdominal and spinal muscles that controls the pelvis from above as well as contributes to the balance of the body from above. This is true for all postures also.

Details will be discussed in later chapters of how to remain neutral in threedimensions with dynamic postures like squatting and walking. Dynamic postures are important because dynamic three-dimensional postures can undo the stress of fatiguing static postures where just correcting the static postures will only help during the time you maintain them in a neutral position.

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A Note on Repetitive Strain Injuries Repetitive strain injuries are injuries that come from the accumulation of stress on the body at a rate or in an amount that the body cannot grow and adapt to. All repetitive strain injuries have their origin in asymmetrical posture and are therefore all connected.

One thing does lead to another as far as repetitive strain injuries are concerned. Having a strategy for achieving symmetry in our neutral and dynamic postures is the solution for all repetitive strain injuries.

Basically what we need to do is become aware of and then manage the symmetry of our body’s positions and movements in three dimensions. Practicing the exercises in this book, standing, sitting, lying down in the ways I’ve described, and improving the details of your walking can accomplish this.

To achieve three-dimensional whole body symmetry you need to know and practice the neutral joint positions of all your joints so that moving out of a neutral place of rest without strain or injury and then into action becomes automatic.

Chiropractic in combination with these exercises and symmetrical walking can help you fully regain and maintain joint function so you can relearn and attain whole body joint neutrality.

When your body is symmetric your muscles / joint mechanics work more effectively. For example when you have a balanced arm and leg swing during walking, balanced being both right and left sides reaching forward and backward with the same amount of reach in your arms as in your legs you create a wind up and spring back of your spine that conserves energy, maintains body balance and body momentum. Walking becomes effortless and fun.

By contrast when joint and soft tissues are not used equally your balance and energy suffer. This happens in walking when your legs reach further than your arms, when one side does more than the other, and when you push off with one leg to propel yourself forward without reaching out with the upper limbs to provide a spring back of the shoulders and spine. Walking with any of these imbalances soon demands more effort and becomes uncomfortable.

Walking in balance and performing all the tasks we demand of our bodies become much easier and productive when they begin from neutral postures that are practiced with 44 44

three-dimensional symmetry in mind. Because your nervous system is always retraining itself to get used to what you are doing when you retrain it for neutral posture symmetry movement that is effortless and fun will become more normal and automatic. By frequently bringing yourself back to three-dimensional neutrality it will become not only normal for you to be there but awkward for you not to be there.

In conclusion work to stay in neutral as long as you can and as often as possible because these neutral positions lead to movement that is more efficient because they demand less energy, lead to more balanced and productive movement, and reduce the chance of injury.

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First Work with the Parts. Time to focus on the function and awareness of the body parts: The spine and the limbs

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Chapter 3

Hip, Pelvis and 3-D movement [Informative]

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[Informative]

The hip exercise discussed in this chapter is designed to get to the end range of rotation of the hip as it comes into the pelvis. It is a routine that is meant to equally stimulate internal and external rotation throughout the 360 degrees of muscle/tendon attachment around the hip joint. This exercise ought to be done consistently to restore the motion typically lost in daily activities like sitting, standing, and walking. We lose this range of motion because of the side dominance we have developed and a less than optimal stride length. What is typical for most of us throughout the day is to walk with a short stride and never get to the end of a stride where most of the rotation occurs. The other common challenge to efficient functioning of the hip joint is that our side dominance forces the hip to rotate externally more on one side than the other. This hip exercise addresses both of these issues.

(Please note that emphasis on the other ranges of motion like side bending and flexion/extension to achieve full three-dimensional motion, come in the upper back and pelvis exercises we will work on later in this book.)

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The hip joint

The Hip Joint Structure As a body part the hip is often confusing because the general area referred to as the hip includes: the buttock, the thigh, the pelvis and the actual hip which is the femur coming into the acetabulum of the pelvis. The hip joint is where the femur, the long thighbone, comes into a uniquely shaped bone that is the ilium of the pelvis. Two ilium bones and one sacral bone make up the three bones of the pelvis. On the ilium there is a bowl like impression called the acetabulum that articulates with the dome shaped head of the femur. This forms the ball and socket joint of the femur.

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Overlapping muscles

Wind up and Spring Back Note: The mobility of the hip joint is high by comparison to the knee and the pelvis immediately above. This allows the hip joint to flex, rotate, and bend to the side. The hip joint interacts with the iliotibial band a large and elastic tendon that stabilizes the joint.

This band has a great capacity to transmit and store the energy generated by the body’s weight and the powerful muscles of the thigh, pelvis and trunk.

[Practical Exercise] A note on beginning all exercises in this book: these exercises are typically new movements for your body and that means you will be stretching and activating the soft tissues in ways that they may not be used to. This means they will require a transition period of two to four weeks. To make this transition as smooth as possible and to not over do them, follow the standard of implementing the exercises in this book briefly and frequently. That means you should do one set of the exercise five to ten times a day as if

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they were homework exercises. You should do the other exercises once a day three to five times per week. You will soon become so comfortable with these exercises that each will take less than a minute, and the “homework” or “brushing your teeth for your spine” exercises will take less than ten seconds. The transition process for these new exercises will never really end because your body is always adapting to new activities. In time you will become more efficient and aware of when you can get away with doing more of the exercises for performance gains.

The Hip/Pelvis 3 Dimensional Movement Hip circular series – a light, brief, complete and controlled series of movements to open up the hips ability to rotate fully and freely.

This series of movements is a pattern of movements that will be used repeatedly throughout the class. Basically it is a series of steps that move around in a circle much as if you were at the center of a clock stepping around the clock with your right foot and leg and then around the clock with your left. You will step forward to different times on the clock with each leg to help you open up both sides of your hips and pelvis.

Throughout the exercise keep your weight centered as much as possible over your feet and on your heels and balls of your toes. Your body should always stay in the center of the stride.

Here goes: Step forward to twelve o’clock with your right leg far enough to challenge you while maintaining a straight yet not locked knee. At the end of this first stride rotate your right foot inward. From there, step back with the same leg a similar distance to six o’clock but at the end of this stride turn your foot outward. Continue this pattern around the clock using your right foot and leg to step forward and back accompanied by an inward and outward turn of the foot. Step to two and eight, three and nine, four and ten, six and then twelve, eight and two, and nine and three, and finally ten and four. You’ve just completed half of the matrix.

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Now repeat the exercise in the same fashion as the first time, but with the left leg moving in the opposite direction or counter clockwise. Follow the pattern around the clock to complete a full 360 degrees of internal and external rotation.

The Hip-Circular Series

Continue this pattern of the lead stride where the foot turns in, and then the next stride of the lead leg ends with an outward turn. Do this first with right leg, then again with the left leg.

Step forward on a 45 degree angle away from your body midline, and turn your foot inwards. Next step all the way back and turn your foot outward.

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Step straight out to your side and turn your foot in. Step back and across your midline to opposite side and turn your foot outward.

Step back on a 45 degree angle away from your midline and turn your foot inward. Step forward along the same angle and cross over your midline on a 45 degree angle forward and turn foot outward.

Step straight back and turn your leg inward. Step straight forward and turn your leg outward.

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Step back crossing over your midline on a 45 degree angle and turn your foot inward. Step forward along the same angle and turn your foot outward.

Step straight across your midline to the opposite side and turn your foot inward. Step along the same line to the other side and turn your foot outward.

Step forward and cross over your midline on a 45 degree angle and turn your foot inward.

Step back along the same line and turn your foot outward.

Again perform this series with the left leg as well but in a counter clockwise direction.

[Note that with all the circular series exercises there is a front and back to each stride. The 55 55

front portion of each stride the foot turns in while the back half of each stride the foot turns out. The series occurs in a clockwise direction with the right foot leading while the left side pivots and then in a counterclockwise direction when the left is leading and the right leg pivots.]

This initial part of the hip circular series focuses on the hips and works the muscles that cross over the hip joints from the thigh to the pelvis and vice versa. This stretch stimulates both muscle and soft tissue in the hips and pelvis by increasing blood circulation and nerve stimulation. It will also increase your perception of your body’s ability to perform these movements by providing a thorough stretch and turn for the entire hip.

In this circular series the forward movements imitate the most common areas of our daily movement in the overlapping muscles of the hip. Most of our daily exercise ends there. The hip circular series however stretches the entire hip by including the back 90 degrees as well as the inside and outside 90 degrees the hip is able to move through. These muscles are utilized at the end of a long stride, but since we rarely take a long stride, where the stride is initiated from the core, those muscles and tendons are seldom used. A typical short stride that is initiated at the knee or hip fails to activate or stretch these hip rotators.

Consequently the muscles get weak and tight from under-utilization. Without such hip rotation the hip joint and bone will grow weak and unstable simply from lack of use.

Some of the movements in this hip rotational stretch series may leave your muscles tight and sore. If this happens it’s because the muscles involved were weak and in need of stretching. Your job is to be careful. If pain is the result of any of these exercises it’s a good possibility that you have done too much. Do all movements only briefly. Brief repetitions done consistently will lead in time to longer and more productive stretches. As your muscles become stronger, they will become healthier and more resilient. The pain you may feel initially will disappear because as your body builds better physical coordination new patterns will be created in the nervous system which will make these movements more automatic. Frequent stimulation of the nervous system interrupts the old pattern of movement. It helps create newer healthier patterns.

Exercises that are practiced briefly and frequently are better for making a change to the nervous system than those that are long and/or intense. Doing these exercises for ten 56 56

to thirty seconds multiple times a day is far better than doing them once over and over for ten minutes. Doing one forward and backward stride or one side-to-side stride with each leg ten times a day is far better for establishing a new pattern in the nervous system. Such a routine will break old patterns much more quickly than doing such exercises just once a day for five to ten minutes. Frequent repetition builds consistency and nerve memory.

Awareness Builder The hip circular series will make you: 

Aware of the internal and external rotation abilities of the right and left hips



Aware of the smooth interaction of movement between the thigh, hip, and pelvis when these areas work together

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Have a greater appreciation for the upper attachment of the thigh muscles into the pelvis

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Feel how your balance is affected by the imbalance of muscle strength, as well as the flexibility and coordination of the thigh and pelvis. This can be identified when you take different steps in the series and discover the imbalance that is present.

All these sensations can be felt at the end of a long stride in which you have reached forward and backward with your right and left legs and arms. Such a stride rotates the hips relative to the pelvis and then the pelvis relative to the abdomen and low back. The hip circular series is a good place to begin your awareness building of how to move in three dimensions. It is also a good place to begin building your awareness of how the hip moves when you walk with the long stride.

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Chapter 3 Low Back

Low Back / Lumbar spine

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[Informative] The exercise in this chapter is designed to focus on the rotational component of the lower back by providing a specific counter rotation of the pelvis and the lower back in order to get to the 360 degrees of muscular attachment around the pelvis and trunk.

In our daily exercise we lose connection with this functional capability of our low back because our typical stride is short and involves only the legs. In this way of moving the trunk of our body is just carried along like a passenger. Moving in such a way we lose the very efficient and healthy wind up and spring back the hip, pelvis and low back are designed to provide. (Please note that emphasis on the other ranges of motion needed to achieve full three-dimensional motion in the upper back and pelvis will be provided in exercises later in the book.)

The Structure of the Lumbar Spine (Low back)

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The low back consists of the five bones called vertebrae and five discs. The bones are very strong and contain protuberances for muscle attachments that control small and large intervertebral movements. The joints in the spine are made of a disc up front and two synovial joints in the back. The discs, the overlapping joint capsule, ligaments, muscles tendons, and fascia hold the vertebrae together. All of these tissues have elastic fibers in them that contribute to the shock absorption and energy transfer that occur in the many different directions that movement can pull the body.

Each segment of two vertebrae and one disc is meant to move through the three dimensions I have discussed. These include flexion and extension, bending right and left, and rotating left and right. These movements ought to occur during any whole body functional movement such as walking or running and they do to varying degrees. Because the tissues in this area are so strong this area also does an amazing job absorbing shock from above and below.

Studies show that the low back is vulnerable to high loads that involve side bending with combinations that involve flexion and rotations. The low back deals with similar stressors especially when we are walking or running. When stress, weakness, and vulnerability builds up in this area it may lead to major injury especially when there is present a significant side dominance that creates an imbalance in right and left movement.

The joints in this area of the spine are in their neutral position when a slight curve is established convex to the front with the apex at the top of the iliac crest. The curve absorbs shock that may be created by the body’s weight impacting the ground with each step. It manages this shock best when the curve stays within a small range of its neutral position. This curve is counterbalanced by the sacral [pelvis] and thoracic [upper back] curves. The curve is very mobile and is affected by upper and lower limb position and movement as well. [Position is very important to its effectiveness.]

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This area is designed to manage heavy loads that are shared equally among all five segments of the lumbar spine. The biggest stressor with static posture to the lumbar spine is too much flexion while sitting and too much extension when standing. With dynamic postures like walking, running and squatting too much onesided torsion from the combination of rotation and side bending will also cause stress.

Wind Up and Spring Back Note: The joint mobility in this area of the spine is high relative to the surrounding pelvis immediately below and thoracic spine immediately above.

A notable joint/soft tissue interaction in this area is in the strong and elastic thoracolumbar fascia that transfers force from the upper body to the lower body via the arm swing, leg swing, and torsion of the spine that is created as the arms and legs swing forward and backward.

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[Practical Exercise] Low-Back circular series

The low back circular series exercise mimics the normal, anatomically designed fulllength stride. It mimics the step of the leg, and creates a rotation in one direction for the thigh, pelvis and lower spine as well as a rotation of the upper body, shoulder and arms as they move in the opposite direction. This counter rotation acts as a mechanism for stretching and winding up the elastic soft tissues of the muscles, tendons, ligaments and fascia so that the energy stored in them can spring back to the direction and position from which they came. This storing of energy reduces the need for additional energy to be put into muscle contraction. Consequently energy is conserved. This stretching activates more muscle fibers by basically stimulating the stretch receptors that are in the tendons. This allows the muscles to contract more quickly and powerfully.

The increased circulation and cellular respiration in these end range tissues that occurs as a result of this stretch keeps them healthier, stronger, and more resilient. The greater range of motion that the stretch creates serves to produce more power in the muscles and, because the mechanical advantage is improved, you will be able to move more easily. Finally, because the counter rotation of the joints in this stretching exercise involves more tissue fibers the load is spread over a greater muscle area, and so there will be less fatigue from over use of a smaller area. In a nutshell, practicing this exercise will give you better muscular performance and quicker recovery from activity.

To begin this series of movements stand in the upright neutral standing position holding a rigid foam noodle or broomstick behind your back. Your palms should face forward to allow your arms to rotate outward and your shoulder blades to remain in a neutral position. While doing this exercise continue holding the noodle behind your back in order to maintain this neutral, low stress position.

Here goes:

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Step forward to 12 o’clock with your right leg and foot and turn your foot inward.

The stride length should allow for both feet to remain completely on the ground and the hip/knees to remain straight. As you step forward turn your foot inward as you turn your upper body in the opposite direction. Next, step to 6 o’clock with your right foot turned outward away from your center. As you place your foot and gain your balance turn your body and arms in the opposite direction to achieve a full twist of your hips. Continue around the clock to two and eight, three and nine, four and ten as in the first circular series for the hip rotational stretch. When you have completed the steps and turns with your right foot, switch to your left foot and take the same stretches and turns as with your right leg and foot working in a counter clockwise direction.

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The low back circular series exercises.

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The lower back torsion exercise series is effective because it gets to the torsion between the thigh, hip, pelvis and low back that we are designed to get with each stride. We typically miss this altogether when we take short strides and carry the trunk with over active legs. This rotational exercise series for the low back also provides subtle flexion, extension and side bending with integration to the surrounding areas with the upper back series.

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[Again, note that with all the circular series exercises there is a front and back to each stride. The front portion of each stride the foot turns in while the back half of each stride the foot turns out. The series occurs in a clockwise direction with the right foot leading while the left side pivots and then in a counterclockwise direction when the left is leading and the right leg pivots.]

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Awareness Builder after the low-back circular series While working with these exercises you should become more aware of: 

How and where the trunk is attached to the upper part of the pelvis



How the hip is attached to the lower part of the pelvis

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The smooth and easy interaction between the thigh, hip, pelvis and low back and abdomen

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How similar the wind up and spring back that occurs through this area is to walking with a long stride

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The difference between the strength, flexibility, coordination and control in your right and left sides, as well as the front and back of your trunk/pelvis



How imbalance in this area affects the control of balance throughout the whole body. You will especially notice this when you have more or less control of different steps in the series. Some will feel easy. Others will not.

Building this awareness will help you control the pelvis from above in a way that will make you able to identify hidden weakness imbalances, asymmetries, and lack of coordination in the core. Adjusting these through your increased awareness and your use of these stretches will make it much easier for you to build a balanced and symmetrical stride that will undo hidden dominant side push offs and non-dominant side pivots.

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Chapter 5 the core

The Core area

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[Informative] The Core and Its Connections The exercise of this chapter focuses on stretching the interconnections of the pelvis, abdomen, rib cage and the low back in three dimensions. This area can be almost still during walking especially when we walk primarily with the legs and carry the body or trunk as a passenger.

The Core is the center from which all our movements should be initiated and stabilized. Efficient movement that is balanced and involves the whole body should be initiated through the core and travel through it. But because of the way we carry ourselves throughout our daily activities we typically are slightly forward hanging our body’s weight on our back and buttock muscles thus shutting off our abdominals. Because our movement begins and continues without engagement of our core our legs must carry around our trunk. Many of us walk this way and never question if this is the right way to move or not, largely because we have always walked this way.

The core is made of a large band of muscles starting with the diaphragm on top, the abdominals on the front and sides, the spine and paraspinal muscles around the back, and the pelvis, including the pelvic floor muscles, on the bottom.

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The core from the front and back, top and bottom, and the sides.

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This area should not be thought of as a solid block of tissue that is separate from the rest of the body. Instead it is totally connected and should be the source of control and stability as we move about. The way we typically train though is as if the core was separate.

We ignore the core as an integral part of all the else and save it for exercises of its own.

Exercising in this way is incorrect.

Every exercise routine should have a core component that is built to include threedimensional movement. I teach three separate classes on the interconnections of the core with the rest of the body in order to help my students and patients rebuild and make automatic Core initiated movement. For the purpose of this book I will focus on the threedimensional functional stretch as a way to help you develop an awareness of the abdominals in three dimensions.

[Practical Exercise] Here’s the exercise: Place your feet shoulder width apart and pointing straight ahead. Take a stride forward with one leg into a lunge position. Your body’s weight should be balanced equally on both feet between the heels and the balls of the toes. Don’t make an effort to gain control of your balance by gripping the ground with the tips of the toes. Your lower limbs may initially be tight so when you take this long stride forward to a lunge position the heel of the back foot may come off the ground. The goal would be to perform this exercise with both heels completely on the ground [see stretches for the lower limb section]. For now, if it is not on the floor, there is no need to worry about that.

The forward lunge position has the knee of the front leg behind or in line with the ankle but not in front of it. In order to initiate this lunge from the core it should start at the low back/pelvis and hip/pelvis connections rather than from the lower thigh, knee and 71 71

leg/ankle/foot. (Please be aware that the knee and the ankle may feel awkward at first because we have a strong tendency throughout our daily activities to control our movements from our hips, knees, ankles and feet. In time this too will pass.)

Once you are in a stable, abdominally controlled lunge position reach your arms overhead as high as you can while maintaining them parallel to one another. Holding on to a foam noodle or broom handle will help make this easier. This upward reach provides a good stretch for the spine, core, hips, and shoulders and activates these muscles so that you are able to exert control over your balance from the upper body rather than your lower body.

With arms reaching up, the palms of the hands should be facing forward, or even better, inward to position the shoulder as close to neutral as possible.

From this centered lunge with overhead reach position you will now add threedimensional movements. Lunge forward and then bend side-to-side five or six times while holding the noodle over your head. Do this first with the right foot forward, then with the left foot forward.

For the next part of this exercise: lunge forward while reaching overhead, and rotate side-to-side and back and forth three or four times. Do this first with the right foot forward then with the left foot forward.

Finally, reaching up overhead while in the lunge position, bend back as far as is comfortable, then lunge a little deeper by bending more at the low back/pelvis and hip/pelvis while maintaining the overhead reach.

This series may be smoother if you do all three of the movements - side bending, rotation, forward and backward - on one side and then on the other side. However, both ways have their benefits.

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This exercise effectively stretches the core and its attachments in three dimensions.

The activation of the muscle fibers and the stimulation to the stretch sensitive nerve fibers is the first step in building your awareness and control over your core. It will help you transfer this control to a more efficient way of walking that is healthier for the muscles joints and soft tissues of your whole body

Note on Wind Up and Spring Back as Part of Three-Dimensional Movement and the Walking Cycle: The core can be thought of as being one large, elastic, soft tissue spring that has lots of power and exercises much control. It is composed of a group of muscles that connect the ribs to the pelvis and the pelvis to the ribs, at the same time as it is rotating and bending at the central spine. Because the ribs above and the pelvis below gives these muscles such a firm base of support there is a lot of potential energy output available from the simple wind up and spring back created by a twist of the body in the upright neutral position. This can be lost though if you are leaning slightly forward or backward with the back and not the whole body.

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Management of this wind up and spring back begins with awareness of how these muscles are built to do exactly this. If the core is weak or you have poor control over it all your movements become less effective because the energy of this wind up and spring back cannot travel efficiently through this area. When that happens more limb energy must be put in, especially from the lower limbs, to achieve any of the movements we are used to taking or wish to make part of our routine of movement and exercise.

Awareness Builder Key things to become aware of with this exercise are: 

How this stretch feels in the upper portions of the core where it attaches in the lower core to the lower rib cage and to the pelvic bowl (inner part of the pelvis).

Feel the difference on the right and left sides as well as front and back.



Once you feel that difference, self assess any tightness, coordination, flexibility and strength imbalances that may exist and then balance your stance so that you feel the stretch equally in each part of your core.



Notice how this three-dimensional stretch of your elongated spine and abdominal muscles mimics the feel of the long stride.



Notice, if you use a small step as part of your walking how this three-dimensional stretch of your elongated spine and abdominal muscles does not feel like your typical short stride. If you can’t feel this elongation in your stride it’s time to begin taking a more effective longer stride.

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Chapter 6 The Ribs

The Ribs

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[Informative]

The Ribs Circular Series gets to the intrinsic muscle attachments of the pelvic girdle, shoulder girdle, and rib cage. This exercise is not only good for improving our breathing, but it also works on improving the arm swing and leg swing during the walking cycle. It gets to the muscles between the ribs - the intercostals - and frees up the motion of the ribs with inhalation and exhalation. It also works the spine motion in three dimensions especially at the junction between the upper and lower back called the T/L junction. This is a particularly stressful area of the spine where the highly mobile low back joins the low mobility upper back. When we round forward from fatigue of long periods of sitting, standing, walking and running we often hang our whole upper body weight on this area.

The bones and joints

The overlapping muscles

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*Note on Wind Up and Spring Back: This area has very low mobility relative to the low back below and the neck above. It creates a large three-dimensional space much like the pelvis and, like the pelvis, it provides a great source of leverage for the soft tissues of the core.

[Practical Exercise] The exercise: Do the following at each point along the round the clock circular series.

Step forward to six o’clock to start the round the clock matrix series. This time reach your arms overhead while holding a foam noodle or broom handle. As you place your foot toward the inside rotate your body in the opposite direction while reaching your arms over head. As you finish that turn, lean your body away from the direction from which you have turned. Now take a deep breath to expand the rib cage and further stretch the trunk muscles. Having completed this first step follow the matrix around the clock as you did in the previous matrixes we have practiced. Remember that after you complete a series with one foot and leg you repeat the matrix with the other foot and leg.

Figure: Reaching and rotating with side bending to isolate the junction between the upper and lower back spinal joints and the muscles of the trunk and rib cage.

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When you begin the rib circular series remember that these muscles rarely get isolated and doing this exercise too zealously may easily overstretch them. Because we walk from our hips or knees and not from our pelvis these muscles don’t work at all, especially since we rarely take a deep breath when walking in this way. With that in mind I would like to stress this series should not be done until you have thoroughly practiced and gotten used to the stretch involved in the other three circular series exercises. (You may want to start with just the portion of the series that involves stepping to the right and left sides and then work up to more of the whole circular series.) Doing this stretch can easily over stretch the muscles involved. A sprained intercostal muscle is very uncomfortable and can feel like more than just a sprained muscle. Go slow and do try this exercise in a way that will build up your ability to do it more deeply.

However, the additional function you gain will be well worth the effort because as you practice this exercise the increase of flexibility in this area will yield a dramatic and positive effect for your walking cycle.

Awareness Builder for the Rib Circular Series This series of exercises will make you more aware of: 

How the muscles that overlap the low back, abdomen, and lower rib cage can be isolated and stretched in three dimensions



How the muscles between the ribs can be stretched in three dimensions



How the muscles close to the spine where the two major curves of the upper back and lower back come together can be stretched.

The area of the upper back is often rigid and dysfunctional because of the stress poor posture puts on it. Despite its rigidity it does put up with a great deal of stress largely due to the stabilizing influence of the rib cage. Building your awareness of this upper back rigidity and taking care of it frequently with such a brief and specific exercise such as this is crucial to taking care of this junction area between the upper and lower portions of the spine and back. If this area is not cleared through exercise of this kind it can become a

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major stopping point in energy transfer up and down the spine. When that happens it becomes a hindrance to the control and balance of your sitting, standing, walking, running and squatting postures.

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Chapter 7 Upper Back

The upper back / Thoracic spine

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[Informative] This exercise isolates the upper back and moves it through three dimensions.

Adding that kind of movement to your exercise routine is important for the joints in this area of the spine because too often they move very little when compared to movements of the neck and low back. After long periods of sitting, standing, walking, and running in which we have built up a good deal of posture fatigue we depend on the rib cage to provide us with the relief we seek. So we slump on a couch or in a chair which forces us into a forward flexion position that provides the upper back with the only movement this area gets – we round it forward. This forward rounding is biggest stressor to this area because too much flexion overstretches the soft tissues and joints in the back and over compresses the joints in the front. With chronic poor posture this can injure tissues and lessen the natural mechanical advantage of this area.

This exercise will stimulate the upper back with just small movements in the other five directions of full three-dimensional movement. It will make a world of difference for the health of the joints in this area of the spine as well as the function of the whole spine and body. This side bending and flexion/extension movements in this exercise for the upper back also provide a complete three-dimensional movement for the lower back.

The Thoracic Spine structure [The upper back] The upper back consists of twelve bones and twelve discs. These are the segments in the spine that have ribs attached to them. Just like the lumbar spine these bones are very strong and have numerous protuberances for layers of muscle attachments that move individual segments of the spine as well as multiple vertebral segments. When you look at the spine from the front it is straight and aligned with the sacrum of the pelvis and low back. This straightness can be seen from the hips to the upper back and the neck. The limbs are designed to rotate efficiently about this straight center column.

When you look at the upper back from the side, however, there is a curve at both the top and the bottom of the spine that is rounded backwards. The curves of

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the lower back and the neck run opposite one another in a way that counterbalances each other. This not only helps us maintain body balance from a front to back perspective but it also helps us absorb the shock that is created as our feet strike the ground every time we take a step in running or walking.

Because the spine is flexed and not rigidly straight the joints are able to deal with all this shock absorption by flexing in opposite directions much like springs that curve when loaded and straighten when unloaded. This loading and unloading ability of the spine allows the body to deal with an incredible amount of force over the course of the day. Such a force transfer can happen without much expenditure of energy if we allow the springs to be just loaded and unloaded as we move about.

However, the system is designed to make use of this energy if we learn to use that loading and unloading as part of our dynamic three-dimensional movement. The design is genius!

The joints in the spine are made of a disc up front and two synovial joints in the back. The discs, the overlapping joint capsule, the ligaments, the muscles, the tendons, and the fascia hold the vertebrae together. All of these tissues have elastic fibers in them and they contribute ideally to the shock absorption and energy transfer that can occur in many different directions in the upper back.

Each segment of two vertebrae and one disc is meant to move through each of the three dimensions I have discussed. These include flexion and extension, bending right and left, and rotation left and right. These movements ought to occur during any whole body functional movement such as walking or running and they do to varying degrees. Between the vertebra and the facet joints is the spinal canal where the delicate spinal cord resides. Here the spine interacts with twelve pairs of ribs that allow the spine to be both mobile and protected. This is one reason this area has low mobility so that the spinal cord has more protection while allowing the cervical and lumbar spines to have more control over mobility.

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A Note On Wind Up and Spring Back: The joints of this area of the spine also move in three dimensions and contribute to a wind up and spring back of the spine. Our rib cage is not just a rigid set of protective bones for our internal organs. Because the rib cage is integrally connected to the spine it is also part of the wind up and spring back created when we move in three dimensions. In three dimensions this energy travels through the ribs and dissipates through them. When we do not move in three dimensions there is little movement or stretch through this area. Consequently it stores, rather than dissipates, large amounts of energy. It ought to use this energy as part of functional and effective movement.

That means that this area of the body is very mechanically effective, and we are much better off physically if we learn how to use this part of our body in the way it is designed to be used.

A notable joint/soft tissue interaction that occurs in this area is in the strong and elastic connective tissue of the thoracolumbar fascia. This aids the body in 85 85

taking advantage of the counter rotation of the hips and shoulders that is created by the more rigid upper back and rib cage especially when spinal torsion occurs.

[Practical Exercise] The exercise: Overhead reaches - with 3D movement Before beginning this series of movements assume the neutral standing position. Hold something rigid such as a foam noodle or broom handle above your head in order to maximize the effectiveness of the exercise. This will keep your arms parallel in order to isolate the upper portion of the spine and upper back.

Posture tweaks and pre-exercise preparation

Shift to neutral standing posture.

Tuck chin straight back

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Arms bent to straight for better thoracic spine isolation.

Step one in this exercise is to bend to your right 20 to 30 degrees while reaching upwards as high as possible. Come back to center, and then bend to the left 20 to 30 degrees while remaining in your neutral standing position. There is no need to bend side to side any further than this because the benefit comes from the combination of reaching up high at the same time as you are bending and rotating forward and backward. Your head should move with your body during these bends. Repeat three times.

The overhead reach in this exercise stabilizes the spine and isolates the upper back. The side-to-side movement also stretches your hips and shoulders as you turn and/or bend from your right side to your left.

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Step two of this series continues with the stiff object held above your head. Turn your shoulders 20 or 30 degrees to the right as far as you can comfortably turn them while maintaining your neutral standing position. After returning to center turn to the left as far as you can. Return to center and repeat three times.

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Step three begins in the neutral standing position – hands and object still above your head. Lean back as far as you can comfortably lean and then while maintaining your overhead reach, straighten and then bend into a squat. Keep your weight on your heels, your knees behind your toes, your toes lifted up and not gripping the floor, your thighs parallel, and your knees slightly inside your ankles.

These brief three-dimensional stretches are part of the homework exercises I have frequently given to patients in order to relieve the frequency of sore upper backs caused by poor posture. I encourage my patients to make this series of stretches a part of their regular routine – much like their habit of brushing their teeth. In fact doing these stretches once an hour during the day will provide you welcome relief from the chronic soreness you feel from sitting in a rounded or slumped position. Repetition reinforces these patterns in your muscular memory so that they will begin to break up previous memories by loosening those muscles out of their tight positions.

Remember that once you’ve practiced these movements a few times you will spend no more than ten to fifteen seconds completing the whole pattern. I find that patients who consistently do these exercises for just a few days are easier to adjust after a difficult first adjustment in this area. That’s because they provide a full and easy range of motion that relieves reflexive hyper-tonicity, spasm, joint compression and joint restriction.

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Awareness Builder for the exercises which include an overhead reach in three dimensions [This is for the upper back but holds true for all exercises that include an over head reach] Key things to become aware of as you do this exercise are: 

How the overhead reach isolates and stretches the muscles close to the spine in the upper back and ribs. This is a stretch in three dimensions.



The feeling of looseness in the lower back that comes from the unwinding in rotation, side bending and flexion/extension of the upper back

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How the shoulder girdle and the pelvic girdle move together. This oneness in movement should occur in a balanced and vigorous walking cycle.

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How the upper back and shoulder girdle move loosely and freely together without restriction.

The pull from above in this exercise mimics what should happen with a long stride. In a properly executed long stride the upper limbs should stretch in such a way that the torso is activated in the same way as it is activated for the movement of walking or running. When there is little effort in the upper body an over reliance on the lower body is established for control and balance.

I understand that moving in this way may be difficult to understand, particularly when I attach it to the idea of moving in three dimensions. You will need to go through the motions of these exercises several times before the three-dimensionality of them begins to make sense. Until then fake it, and allow your awareness to build.

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Chapter 8 Neck

The Neck / The Cervical spine

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[Informative] This area of the spine is highly mobile and deals with a great deal of hyperextension in its upper and lower parts. When our day includes long periods of a specific activity this area can easily become sore and tight due to fatigue. That happens because the middle of the neck is held in a flexed position while the rest of the neck tries to stabilize itself in a forward position. When this forward fatigue forced stable position becomes the new normal more compression is put on the joints and soft tissues. All three dimensions of movement are then limited by this forward position because this and the corresponding compression partially lock up the joints. The purpose of the exercise in this chapter is to bring the neck into a neutral position and take it through a full three-dimensional range of motion. Rather than solely focusing on the neck this exercise is coordinated with the upper back movement to more specifically isolate this area of the neck in order to recapture its full mechanical potential.

The neck structure This area of the spine is made up of seven vertebrae and five discs. Two special segments at the upper part of the neck provide the majority of the rotational movement of the neck. Five other segments work in a fashion that is similar to the rest of the spinal segments. These lower five segments in the spine are a disc up front and two synovial joints in the back. The discs and the overlapping joint capsule, ligaments, muscles tendons and fascia hold the vertebrae together. All of these tissues have elastic fibers in them that contribute to the shock absorption and energy transfer that can occur in this area in many different directions.

Each segment of two vertebrae and one disc is meant to move through all of the three dimensions. These include flexion and extension, bending and rotating left and right. These movements ought to occur during any whole body functional movement such as walking or running and they do to varying degrees because this area does an amazing job of absorbing shock.

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The joints in this area of the spine are in a neutral position when a slight convex curve is established that has the apex of the curve in the front and the center of the neck.

This occurs when the center of the ear is lined up with the center of the shoulder. The curve aids in the absorption of shock and counterbalances both the thoracic curve and the skull.

The curve is very mobile and is affected primarily and directly by the position and movement of the upper back and upper limb.

Notable joint/soft tissue interactions and the biggest stressor to the neck are in the over-contraction of the neck and shoulder girdle muscles that work to counterbalance and stabilize the neck and head in a forward position. This “upper cross syndrome� is epidemic in our society. It is caused by how much of our day is spent in a forward bend and forward movement. The increased demand on muscles from this chronic forward deviation from neutral fatigues muscles so much that they may go into spasm. This compresses joints to the point of inflammation and by restricting the easy movement and function of these muscles it creates pain in the head, neck, upper back, chest, shoulder and upper arms.

This area of the spine is designed to almost effortlessly carry an intermediate load that ought to be shared equally by all seven segments of the spine and the neutral shock absorptive curve of the neck. In the short term it can handle the forces of this forward position, but in the long term the muscles fatigue and must hang on with a non-contractile energy that uses the soft tissues and bony joint surfaces to bear the weight of this forward lean. This leads to deformation of the soft tissues and dysfunction of the joints.

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Note on Wind Up and Spring Back: Joint mobility in this area of the spine is high relative to the thoracic spine immediately below and the skull immediately above. The neck can be highly functional and highly mobile because of this counterbalance in mobility.

Because the head stays in a forward looking direction all the time it allows each arm swing to create a gentle but biomechanically efficient and effective counter rotation of the upper back that contributes to the wind up and spring back of the spine.

THE EXERCISE neck three-dimensional functional stretch When patients demonstrate what they have been doing for exercise of the neck it usually involves aggressive pulling of the neck forward or to the side or even a combination of side bending and rotation. They will place their hands at the top of their head and tug one way or the other creating a long lever with their arm from the base of the neck to the top of the head. Doing this puts a lot of force on the joints of the neck. It basically does not respect the health of the joints. It also does not account for the interaction between the neck, upper back and the shoulders. In the end the exercise itself can create tightness and discomfort in the neck.

Often when I see patients with neck complaints for the first time, adjusting is necessary but difficult. Rather than aggressively adjusting them I lightly mobilize their neck and then ask the patient to do the following three-dimensional exercise once or twice an hour. By the 3rd or 4th visit the neck adjustment that was once shocking and uncomfortable becomes easier.

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I’ve found that moving the neck through the three dimensions previously discussed is all it takes to relax and help the neck recover. This movement consists of reaching your arms over your head as high as possible and moving the neck in the opposite direction of the upper back through each of these three dimensions. Stretching the neck in this way reestablishes muscle memory of how the neck is designed to work and reinforces the normal anatomical pattern that the pain and discomfort we experience in this area tells us is missing.

[Practical Exercise]

The neck 3-D functional stretch exercise When I say functional movement I am referring to a movement the body does on a frequent basis without fatigue or injury because it is a movement the body is designed to do efficiently and with little demand placed on any one particular area. This means the area the exercise is focusing on interacts smoothly with the surrounding tissues of the body in three dimensions which we know by now are bending forward and backward; rotating left and right; and side bending left and right.

This exercise is very similar to the upper back 3-D exercise. However, in this exercise your head and neck will move in the opposite direction of the primary movement. These movements are not ones we do often. In fact we do them very seldom. But, because they are so effective, you will find that you quickly become comfortable with them.

Begin in the upright neutral standing position. Reach your arms over head while holding something light and rigid. Keep them as high as you can by straightening your arms at the elbows so that you feel the stretch in your upper back close to the spine. Remember to keep your arms parallel to one another throughout the exercise.

One last piece to remember is, throughout this exercise keep your chin tucked back and parallel to the floor. It may help to visualize a string on top of your head pulling your head, neck and spine upward into its stretched and neutral position.

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Head and neck shift from forward flexed to back neutral.

As you maintain the overhead reach, bend your body from side to side. When you bend to the right with your arms and body your head and neck should bend to the left. As you bend to the left with your arms and body your head and neck should bend to the right. This part of the exercise creates a lot of physical challenge for us because in the three dimensions of movement we are designed to execute, this movement is the one we do least.

Neck isolation functional stretch with overhead reach in three dimensions.

The second step and dimension of movement in this exercise adds a rotation. Continue holding your arms and the stiff object above your head. Now rotate your arms, shoulders, and body around to the right, and at the same time rotate your head and neck to the left. Then rotate your arms, shoulders and body to the left, and at the same time rotate your head and neck to the right.

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Step three involves forward and backward movement. Begin or continue in the neutral standing position, still holding your arms with a stiff object above your head, and then lean back as far as you comfortably can while bending your head and neck forward. Come back to the neutral standing position (feet pointed straight ahead) and move into a squat while reaching up with your arms and leaning your head back. Your squat should be executed as we practiced before. Your weight should be shared between the balls of the feet and the heels, your toes should lift up, and your knees should be behind your toes and slightly inside your ankles.

Perform this series of movements several times within a comfortable range of motion.

The overhead reach in this exercise improves your upper back mobility, and it emphasizes the interaction between the neck, shoulder and upper back. This kind of interaction between the neck and upper back happens when we walk. With each stride we take the arm swing should slightly rotate the upper back. At the same time, as the arm is swinging and the upper back is rotating, the head and neck will be looking straight ahead. They should not be

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rotating. This assists in creating a relative counter rotation of the neck and upper back. The arm swing is effective for creating a wind up and spring back for shock absorption and energy transfer. Keeping the head straight also keeps us from becoming nauseated. We are designed to move in this way. It is functional for us to counter rotate our head and neck relative to our upper back.

The side bending, flexing and extending motions of the head and neck in this exercise work the muscles that overlap the upper back, shoulders and neck. This serves to create a counterbalance against the downward pull of gravity in the upper back and neck both in a side to side movement as well as in the forward and backward direction.

The neck 3d movement exercise is effective because the neck is usually working by itself. Again to review what is typical, the upper back is rounded forward and locked up, and the shoulders are up and forward. This often restricts its motion and adds to restricting the neck motion by pulling it forward. The neck in a forward position is limited from moving through a full range of motion in any direction. This exercise pulls you back into neutral by opening up the joints to move freely in all directions. When the neck moves through each of the three dimensions it works together with the upper back and shoulders.

Awareness Builder for the neck three-dimensional functional stretch When doing this exercise be aware of: 

How fluid the movement between the neck and upper back can feel when the chin is tucked straight back and the neck is elongated



How the neck feels when a neutral curve is created by tucking the chin in and elongating the neck upwards

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How moving the neck in three dimensions provides flexibility, strength and coordination not only in the neck but also in the connection between the shoulder and the neck.

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Appreciating the details of spinal movement will build your control of the small muscles around the spine and in time enable you to initiate movements from there that can be more powerful and done with less effort. The movements of your neck are designed to start from here, but many of us work away from such a pattern of movement because of the stresses of daily activities. Once we’ve lost that ability we quite often don’t know how to find our way back. Using these exercises and becoming aware of how movement begins in this area is the quickest way to undo the forward head tilt that has become a painful part of many of our postures.

These exercises can make our static postures become more comfortable and easier to perform correctly.

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Chapter 9 Shoulder

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[Informative] The Shoulder Girdle This shoulder girdle is a highly mobile floating joint complex that relies on surrounding tissues for strength, stability and mechanical advantage. Its only bony attachment to the body of the skeleton is at the collarbone where it attaches the arm to the chest. As a floating joint the shoulder girdle has more range of motion than any other because more than twenty-five muscles control its movement. It relies on the contribution of each of its four joints to achieve stability when moving. For these reasons, exercise of this area should strongly integrate the surrounding areas, and the more aware you are of how this motion ought to happen the more effectively you will be able to exercise it.

The exercises chosen for this area address the issues of elevation and forward rounding that are a common feature of our daily activities. We reflexively resist the forward rounding by contracting the muscles that also elevate the shoulders. The forward rounding occurs primarily due to the constant forward focus of our daily activities.

Basically your shoulders are hunched toward your ears and in this position your arm movements are limited by the impingement of the rotator cuff muscles and tendons where the arm, shoulder blade and chest come together. This over forward position of the shoulder girdle is epidemic in our forward moving society and it increases postural stress on the neck and upper back. It limits not just the function of the shoulder, neck, and upper back, but the whole body because of the effect it has on the swing of the arm.

The Shoulder Girdle Structure This area consists of four joints with three bones. The bones are the humerus or the arm, the scapula or shoulder blade which is connected to the rib cage through the scapulothoracic joint at the back and to the clavicle or collar bone up front at the acromioclavicular joint; the clavicle also connects to the chest at the sternum through the sternoclavicular joint. The arm to shoulder blade joint is former by ball and socket that is smaller and shallower than the hip-joint ball and socket. As a result it is more mobile, but consequently less stable and not nearly as strong.

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Three of the four joints that make up the shoulder girdle are synovial, which means they fluid filled and enclosed by a ligamentous capsule. These joints are stabilized by the ligaments and over lapping muscles and tendons that are attached to them The joint between the shoulder blade and the rib cage, which is called the scapulothoracic joint, is stabilized by muscles, tendons and the fascia, fascia being an elastic and possibly contractile tissue that connects soft tissues together. This atypical attachment is primarily why the shoulder is seen as a floating joint.

The neutral position for the arm is when it is at the side of the body and the palm is facing the body. Because of forward rounding and elevation of the shoulders the arm is often in front of the body and rotated so that the palm is facing backward.

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A Note On Wind Up and Spring Back: The mobility of the shoulder girdle is high relative to the surrounding elbow below and the rib cage and thoracic spine above.

I often have patients demonstrate several shoulder exercises for me and without fail they demonstrate a lack of awareness and control of both shoulder movement and neutral positioning. I can see the same lack of awareness when I watch people walk in the airport or mall. Most walk without an awareness of the role the shoulders play in winding the upper body up and releasing it so that a full three dimensional movement is possible. The shoulder blade, when pulled back, should come down equally on both sides toward the spine, and the pull back should have a continuous feel or connection to the upper abdominals as the torso rotates slightly. I must say I rarely see this happening without training and prompting.

The shoulder basically allows the arm to move in complex three-dimensional movements. The control of a single plane or one-dimensional movement is at least partly made up of the muscle attachments. Integration of single plane movements is influenced by the connective tissue between the muscle, tendons and fascia. All of these tissues are controlled and coordinated by the nervous system.

When we consistently perform a pattern of movements with the arm and shoulder the nervous system creates a pathway that makes it easier to reproduce that pattern again and again. As movement becomes automatic we move with less awareness of it. The more you perform that pattern the less aware you become of what makes up that pattern. This is good in one sense because it gives you the ability to focus on other things, but it is bad in another sense because missing the details of the movement could lead you toward injury.

Being aware of how you move is important, especially with the shoulder, because of its mobility and the complexity of the demands put on it. Being aware will help you build efficient movement that is good for performance, injury prevention and recovery. If we miss the subtle strains from ineffective movement that we repeat over and over again then we are building the underpinnings of repetitive strain injuries and creating greater potential for severe injuries. Without a plan for shoulder maintenance and health that can

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overcome this lack of awareness, we continue to build a network of possible injuries and discomfort.

Typical exercises for the shoulder include pull downs, rows, shoulder presses, shrugs, overhead presses, pull-ups, and push-ups. All these exercises compound problems in the shoulder if they are not initiated from the muscles that pull the shoulder blades down and toward the spine. This is very tricky to perform correctly and often require one on one instruction and feedback to correct.

The muscles that elevate and at the same time pull the shoulders forward are the muscles that are used incorrectly to perform these exercises. This may be a carry-over from our poor sitting and walking postures that create a pattern of movement that does not respect the neutral positions and three-dimensional movement capabilities of the joints and muscles. Using the wrong muscles detracts from the smooth interaction between the neck, upper back, and shoulders. It ultimately makes you susceptible to injury and poor performance.

The easy plan for the shoulder is the exercise in this chapter, but the more complete plan can be found in exercises that help integrate shoulder and arm movement into movements that are designed to work with the rest of the body. Those kinds of exercises are found in the walking cycle that we will get to.

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In the exercise that follows are several movements for developing three dimensional shoulder health

[Practical Exercise] The Exercise: 3 dimensional shoulder blade retractions

Stand in the neutral body position and lift your arms like wings to shoulder height.

Keep your elbows straight, but not locked, and your palms facing down. In this position, stretch out the ends of the fingers to create traction in the arms and activate the shoulders.

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As you do this learn to appreciate the connection between the neck and upper back. This will also give you more balance and control throughout the stretch.

The next step is to rotate your arms so that your palms face upward. As you perform this be aware of how your shoulder blades move down as your palms turn upward. Follow that downward movement and pull your shoulder blades down further toward the spine.

The goal is to keep the shoulder blades retracted throughout the exercise. This retraction has two benefits. The first is that it allows the nervous system to build the coordination and strength that is needed to control these muscles throughout the full range of motion the exercise requires. The second is to build muscle memory of the neutral shoulder position we need during daily activities. Each of these benefits will improve your daily movement performance, limit injury, and decrease recovery time from injury.

First set of movements: With your arms positioned as above, rotate your body to the right and then to the left while maintaining your stretch through the complete rotation. Your head and neck should move in the same direction as your arms, shoulders, and body. After three to five repetitions come back to the neutral/start position.

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Second set of movements: Bend side to side – head, neck, and whole body – while maintaining your shoulders in the retracted neutral position throughout the exercise. After three to five repetitions come back to the neutral/start position. Again, check that shoulders maintain their retracted position.

Third set of movements: End the series by leaning back as far as you comfortably can - arms and shoulders retracted of course. Now come forward into a neutral balanced squat (toes lifted, weight on your heels, knees behind your toes) while keeping your arms and shoulders in a neutral, retracted position. How many squats can you do? One’s great. Two is awesome! Three is outstanding! This is an excellent activation exercise for the shoulder blade retractor muscles.

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This exercise series is not by itself enough to change the forward rounding and elevation of the shoulders that cause you pain. It provides only part of the steps involved in improving how this part of your body functions. Because of the chronic abuse the shoulders take there are several small variations of these exercises that I recommend. These variations will comprehensively strengthen and stretch not just the shoulders but they will improve control of the arm swing as well.

The first variation is to repeat the same three maneuvers you just learned, but this time rather than moving your head and neck with your body, move the head and neck in the opposite direction of the body. This variation will allow improved neck mobility and better control over the upper back.

Side bending with body one-way head and neck moving in the opposite direction

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Rotate the body one way and the head and neck the opposite

Extend the body and bring the head forward, squat to flex the body and bring the head back

The second variation involves changing the angle of your arms. Rather than holding that ninety degree angle straight out from your shoulders, reach both arms toward the sky at a thirty degree angle; and then do the series again with the arms angled down at thirty degrees. Again go through the same pattern of movements, bending side-to-side and turning side-to-side. As before, do these exercises by moving your head and neck with the body, and then with your head and neck moving opposite the body.

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These variations to isolate the neck and upper back muscles will effectively improve the movement of your upper body. Because there are so many variations it is important to limit yourself to two or three repetitions. More than this is unnecessary because of their significant overlap … and, don’t forget our rule that brief and frequent exercise is more beneficial than long and infrequent exercise.

Shoulder blade retraction variations with upward and downward 30 degreeangle with three-dimensional torso bending.

Awareness Builder for the shoulder girdle exercises As you do these exercises become: 

Aware of the interaction between the upper back/rib cage, and the shoulder girdle, as well as neck and the shoulder girdle. Feel how they move and integrate together



Notice how different it is to move the shoulder blade back and up as opposed back and down.



Feel how each of these shoulder parts become stronger, more flexible, mobile, and coordinated as they become part of the arm swing while walking

Building awareness through these exercises will help undo the stress of impingement on the front of the shoulder. It will help you develop the habit of pulling the shoulder

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blades back and down so you can feel the connection between the shoulder and the core.

Once you become aware of this you will begin to feel where the power from the upper body comes from.

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Chapter 10 Remainder of the upper limbs - the arm, elbow, forearm, wrist and hand

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[Informative] The arm, elbow, forearm, wrist and hand Now is a great time to talk about all the rest of the upper limbs. I’ll begin with the elbow, which is similar in many ways to the knee, just as the wrist and hand are similar to the ankle and foot. In both, flexion is the predominant movement. Flexion can often be over done to the point of a repetitive strain injury such as tennis or golfer’s elbow, or carpal tunnel syndrome. During the walking cycle we give little thought to the hand/wrist and elbow, they typically are held motionless as they swing with the arms. Sometimes because of side dominance the arm on the dominant side will swing a bit while the other is held more or less still. I see missed opportunities in this lack of movement.

The first missed opportunity is the chance to pump circulation through the hand/wrist, forearm and elbow to help them recover from the repetitive strain of daily activities. The second is to rotate the upper arm in a fashion that contributes to movement in the shoulder blade. Winding up the soft tissues of the arm would promote better shoulder blade movement control. Both these can be accomplished by adding more rotation and side bending motion to the arm swing as part of walking. The following exercise will aid in this process. Further details of improving the quality of movement during the arm swing will be discussed in the chapter on the walking cycle.

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Wind up and spring back note: Mobility at the hand and wrist is high relative to the elbow immediately above.

Elbow mobility is low relative to the wrist immediately below and the shoulder immediately above.

In the hand, wrist, and forearm there are numerous bones and joints that can adapt to many specific movements. What is most important is that these joints frequently get general motion in each of the three dimensions. What happens all too often is that their range of motion is limited to one specific task or exercise. The intent of the following exercises is to keep these joints fully functional so they can continue to adapt to any movement when necessary.

[Practical Exercise]

Wrist flexion and extension range of motion exercise.

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Wrist side bending range of motion exercise: begin with reaching through the ends of your fingers.

Wrist rotation range of motion exercise: begin with reaching through the ends of your fingers. First with wrists bent up.

Second with wrists bent down.

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Elbow flexion with forearm and wrist internal rotation. Perform slowly and control the curl on the way up and on the way back down.

Elbow extension with forearm and wrist external rotation. Perform slowly and control the curl on the way up and on the way back down.

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Awareness Builder for three-dimensional wrist movements Key things to become aware of with this exercise are: 

The forearm can and does move through three dimensions



It is harder to move the wrist and forearm by themselves than it is to move the wrist, forearm, elbow and arm all together



How the forearm and wrist interact together as well as how the forearm and arm interact.



How the forearm and wrist do more when you walk than just hang there and swing a little.

The key benefit of being more aware of the three-dimensional wrist and forearm

movement is that it makes the arm swing more productive by preloading the arm and shoulder. Secondly this wind-up motion of the wrist and forearm acts like a pump to improve the circulation to the wrist and forearm. Straining these areas repeatedly and without relief leads to injuries like carpal tunnel syndrome and golfer or tennis elbow.

Using them as this exercise encourages will help protect you from these injuries and may reduce the pain you feel if you do suffer from these injuries.

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Chapter 11 The Knee, the Pelvis and Squats [a series of squats for lower limb integrated movement].

The Knee

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Informative The knee can be exercised by learning to control the hip and pelvis above and the foot, ankle, and leg below. We too often try to control bending of the lower limb with the knee. Unfortunately, this is where all of knee’s problems typically start. Bending at the knee puts it out of position and demands too much from it. The squat is an excellent movement for the knee as long as the control of the squat does not come from the knee, but instead from the feet, hip, pelvis, and core. The squat is also an excellent exercise for the pelvis because much of the control of the movement ought to come from the pelvis. Done properly this squat exercise can help us understand a bit better how the pelvis functions.

The knee is a large joint that bears a lot of weight and is very flexion dominant. By bending and straightening as it does the knee is the major component in absorbing the impact shock of our squatting, walking, jumping, and running. Because of its importance in all these movements it is vital for us to be aware of the details of movement in three dimensions of the knee joint. We must also build our understanding of how the knee interacts with the foot/ankle and the hip. This will be the focus of the squat exercises and its variations in this chapter.

The knee and the hip pronate and supinate in the same way as the foot and ankle.

Pronation is the combination of bending or flexing, adducting (moving toward the body midline with internal rotation0. Supination is the combination of extension or straightening - moving away from the body midline with external rotation. These muscles and joints work together with great mechanical advantage.

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The Knee Structure The mid part of the lower leg consists of four bones and three joints. The patella is a floating bone within a tendon at the front of the thigh muscle that covers the front of the knee and travels in a grove up to the thighbone. This floating bone adds significant mechanical advantage to the bend of the knee. The other two knee joints are filled with synovial fluid. These are encapsulated and held together by ligaments and overlapping tendons.

A notable joint and soft tissue interaction in the knee is between the large elastic patellar tendon and the large quadriceps muscle at the front of the thigh. It provides mechanical advantage and power for the work of lifting, running etc. This tendon and joint surface under the patella are prone to repetitive strain injury due to too much flexion in the knee and outward rotation of the lower limb.

Wind-up and spring back note: The knee’s mobility in three dimensions is low relative to the foot/ankle immediately below and the hip immediately above. The knee’s dominant movements include flexion first, then rotation, and finally side bending.

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The best exercise to work the knee in three dimensions is the squat and the same is true for the pelvis. I will first describe the pelvis and then go through the squat in more detail.

Pelvis The pelvis is built with three bones that form a ring. It has one joint in the front and middle and two joints in the back just beside the bottom of the spinal column. This design allows it to transfer force from two legs into the spine and then back from the spine to the legs. For the optimum health of these joints and maximum efficiency/performance of the whole body these bones must work symmetrically. Unfortunately this area is often where most of our asymmetry hides. I believe that happens because we are much more aware of what happens at the ends of our limbs rather than of what is going on in our trunk where the movement begins. This may be due to the much higher concentration of sensory nerve endings at the end of the legs, which are necessary for establishing awareness of our balance and mobility. By becoming more aware of the origin of movement in the trunk we can build much greater stability for the balance and mobility of the whole body.

This series of exercises is designed to get at the full three-dimensional movement the pelvis is designed to manage. The legs and the low back are both involved in flexing and extending. For the legs the flexing and extending will involve the muscles and the bones of the thigh, knee, lower leg, and so on into the ankle, foot and toes. The exercise also extends a similar stretch and flex into the back/pelvis and all the bones and muscles attached above.

Each variation of the exercise is designed to get at this three-dimensional potential of the pelvis. It includes the challenge of an overhead reach to involve the upper body. By bending side-to-side and rotating the upper body, lower body control is challenged and built. Throughout the exercises the lower body must remain straight and parallel. This can only be done by managing the inner and outer thighs during the up and down movement of the squat. Once you have learned to keep the lower body straight and parallel both sides of the pelvis will participate equally in the flexing/extending, rotation and side bending of these three-dimensional movements.

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Finally, the last challenge is designed to make sure nothing is hiding in the control of movement in the pelvis. In this part of the exercise one foot is moved forward as part of the squat to imitate the motion of a short stride. This short step creates the kind of challenge the pelvis deals with when walking, and as you learn to squat this way you will train yourself to feel the equal loading of movement on both sides of the pelvis.

Ultimately the goal of this series of exercises is to improve your awareness of the right and left sides of the pelvis so that you can understand how each feels individually and as a working pair. The key is when the feet are offset the knees still need to remain behind the toes on both sides and slightly inside the ankles. Paying attention to this will cause the hips and each side of the pelvis to follow and consequently work independently on each side.

Wind up and spring back note: Mobility of the pelvis is low in three dimensions relative to the surrounding hip immediately below and lumbar spine immediately above.

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Squatting posture [important transitional movement that uses the whole body] The squat is discussed many times in this book. This exercise is a crucial exercise to do properly for the health of the whole body. Understanding how to do it correctly is a process not an event. Each time we talk about the squat it is with greater detail to build on your understanding, your awareness, and your ability to perform it. With greater awareness you will come to understand how crucial it is to body movement, how easy it is to do improperly, and how difficult it is to progress to doing it properly. You will come to understand why almost everyone is doing it subtly wrong and why it is important to do it the right way.

A maneuver like this is one that is very important to do symmetrically in three dimensions to avoid injury and maintain control over joints of the whole body.

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Details: Before you take on this squat exercise take a moment to identify how well you use the pelvis in a balanced fashion by observing the following: when you squat do the legs and feet start out straight and do they easily stay straight throughout the squat? Secondly, does it feel like both feet, legs, and thighs are doing equal work or does one side feel like it is carrying more of a load? If the feet do not stay straight and/or if it feels like the load is shared unequally then you have a problem with balanced use of the pelvis.

To work on clearing up the imbalance for yourself you need to be aware of the following details: bending during a squat occurs at the ankle, the knee, the hip/pelvis and the low back/pelvis. This bending needs to occur equally on both sides. Equal bending at the ankle and knee is easy to observe by keeping the feet straight and knees straight. The knees should stay an equal distance away from the body midline throughout the squat.

The bend of the hip/pelvis can be seen at the front of the pelvis as it moves to the front of the thigh. The bending of the low back/pelvis can be seen as the front of the pelvis tilts forward toward the thigh and the back of the pelvis comes up as the low back muscles contract. This causes the curve in the low back to increase, but you can counter this by drawing the navel to the spine and tightening the pelvic floor (like holding yourself from peeing) in order to contract the lower abdomen.

The two other essential details to build the squat symmetry are these: keep the knees behind the toes and the knees slightly inside the ankles. When your knees are slightly inside the ankles you will feel the inner thigh muscles activate on both sides. When your knees are behind the toes during a squat the demands on the lower limbs changes. It shifts from the calves, knees, and lower thighs that happen when you are forward with knees in front of the toes to the upper thighs, pelvis, and core when the knees are behind the toes. These details need to be paid attention to throughout the entire squat because demands on both sides change as the depth of squat changes.

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If you are aware of the details in the following list of instructions and implement them you will keep yourself from becoming a victim of your own compensations…

Neutral three-dimensions squatting instructions 

Feet straight, as opposed to turned out.

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Feet flat, as opposed to being on the inside or outside of the feet.

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Toes up rather than gripping the ground for control of balance. This keeps the body from pulling forward.

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Bend equally at the knees and ankles to keep the body aligned rather than in a lean to the dominant side.

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Bend hips equally as they come into pelvis so that both the hips and the low back come equally into the pelvis.

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Keep your knees behind your toes in order to support the hips and low back as they come into the pelvis.

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Keep the knees slightly inside of ankles as opposed to outside of ankles to activate the muscles of the inner thigh.

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Draw navel to spine and tighten pelvic floor.

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Do not over arch or round the lower back.

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Pull the shoulders back and down and at the same time as you pull the front of the ribs down toward the front of the pelvis to control the low back curve from above.

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When doing a squat by reaching overhead you will create a pull from the trunk muscles on the top of the pelvis and give yourself more control over the squat from the upper half of your body.

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Tuck chin back to keep head and neck centered from a front to back perspective.

A balanced squat activates all limb and trunk muscles and is an excellent cross training for most daily activities. Done properly it reminds the nervous system of the neutral positions you are striving to practice. Done frequently you will overcome the

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asymmetry of your daily activities and your new normal will be three-dimensionally balanced.

The best part of this kind of squat is that it brings a relaxation to your buttocks and back that the tension of the day has driven into it. You may not immediately feel your back and buttocks relaxing in this way, so be patient with yourself and you will gradually gain a new control over contracting and relaxing the whole buttock instead of over contracting the upper and outer buttocks only. Your back and buttocks have been tight for a long time!

With practice they will grow used to, and happy with, the changes this exercise will bring about for them.

Squatting Postures – The Bad

Feet turned out

Feet turned out

Weight forward

Weight forward

Knees in front of toes

Knees in front of toes

Knees outside ankles

Knees outside ankles

Low back rounded

Low back rounded

Shoulders rounded

Shoulders rounded

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Squatting Postures – The Good

Feet straight

Feet straight

Weight balanced

Weight balanced

Knees behind toes

Knees behind toes

Knees inside ankles

Knees inside ankles

Low back neutral

Low back neutral

Shoulders retracted

Shoulders retracted

[Practical Exercise] The Exercise: Squat to build right/left pelvis awareness with parallel legs and overhead reach Start with your feet straight ahead and your toes curled up. You should feel your weight resting on your heels. Standing in this way centers your body weight during the squat. When you are centered reach your arms over head. Keep them parallel by reaching up as high as you can and maintain this reach throughout the whole exercise. If this is difficult you could try holding something straight and rigid in your hands as in previous exercises. As you squat keep your arms extended above your head - by pulling the shoulder blades down and back your shoulder blades will easily connect to your core from the sides of the rib cage around to the upper abdominals. Once you feel the connection between the shoulder blades to the upper abdominals pull the front of the ribs down to connect the shoulders to the pelvis through the core.

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Now squat, bending so that your left and right sides move together at the ankle, the knees, the hip/pelvis, and the low back/pelvis. Pay attention to activating and contracting the right and left sides of the abdominals and the low back. As you squat you should feel your low back arch because your back and buttocks muscles are tightening because you are drawing your navel in toward your spine. You should feel a pull in the front of your ribs down toward the front of your pelvis to bring about a straightening of the low back curve.

This counterbalance of arching and straightening is meant to bring control over the lower back and pelvis curve by maintaining it in the low stress, neutral position throughout the movement.

Keeping all this in mind is difficult and requires a high level of awareness. My challenge to you is to embrace that challenge and reap the benefits of a more stable pelvis and spine.

Squat a couple of times till you grow accustomed to keeping your body straight and parallel. This keeps your spine and pelvis in a neutral curve. Now here’s the fun part, as you continue squatting and holding your hands overhead begin to bend side to side from your waist but not from your buttocks and hips. Your lower body must hold that balance between the right and left hips. Check your knees and feet. Are they parallel and in line? Do you feel a strain in one hip more than another? If you do, correct that feeling so that the load is carried equally.

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Want more fun? Next, rotate your upper body right to left while squatting up and down. Again, do not let the upper body movement affect the lower body movement and position.

This exercise will feel awkward to begin with as we seldom move this area in so many different ways. Be assured that what you are doing is breaking up old patterns and establishing new ones.

Believe it or not, each step we take during walking and running is like a shallow squat. In each step there is a synchronistic bending and straightening of the ankle, knee, hip/pelvis, and low back/pelvis. This exercise builds your awareness of the mechanical advantage that comes from getting all these parts to work symmetrically.

The squatting exercise you just learned can be altered to help increase your awareness of strength, coordination and control of the right and left sides. As we stated earlier the side that is dominant is the side that is working most effectively when we are

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bending and turning, pushing off and swinging back. In our walking cycle we typically propel our body with our dominant, coordinated side. We then pivot with the nondominant less coordinated side. This asymmetry forces more performance to come from the dominant side and thus sets us up for repetitive strains to accumulate on each side. One side is over worked through a greater range of motion and the other is over worked through a shorter range of motion. This repetitive strain leads to injury and eventually if not addressed can lead to degenerative change. That’s one reason so many older adults are bent and stooped. This additional exercise is one more effort to keep you from slouching into old age.

Typical squat compensations associated with side dominance.

Centered, knees inside ankles, knees behind toes.

Shifting to the right during the squat. Bad.

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Shifting to the right and knees outside the ankles. Bad.

These subtle mistakes demonstrate ways in which our bodies might become misaligned and out of three-dimensional symmetry. If you notice that these mistakes are how you immediately moved when attempting this squat you might well have uncovered an asymmetry in your body’s alignment.

Part of the squat exercise with the overhead reach is to become aware of how much each leg is being loaded and how each leg is bending and controlling at the major joints on the left and right. [Foot/ankle, knee, hip/pelvis, low back/pelvis, spinal curves].

The final exercise is a variation on the one you just learned. It is designed to further challenge you to control each side of the pelvis. The variation is to take a small step forward in order to offset each of your feet. Now do several squats – arms overhead of course. Then when you have the hang of squatting in this way (equal balance and strain in your hips because you’ve kept your weight on your heels, your toes lifted, and your knees behind and slightly inside your ankles), bend side-to-side from your waist and then rotate right and left as before.

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Awareness Builder for right and left squat Key things to become aware of with this exercise are:

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That the overhead reach through the attachment of the upper body to the pelvis contributes to the movement and control of the pelvis from above. The hip and the thigh balance out the effort from below.

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That you feel the overhead reach through the lower ribs, the abdomen and into the pelvic bowl.

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Whether one side or the other of the pelvis is doing more work than the other.

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How the thigh controls the body’s balance when the upper body moves outside the center of the pelvis.

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Remember that the pelvis will tilt forward and the low back will arch too much if you don’t use the abdominals when you squat. Secondly remember that the pelvis tilts backward and the low back rounds too much if you don’t use your low back muscles when you squat. Maintaining a neutral pelvis position from front to back while squatting requires the abdominal and low back muscles to work together.

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Chapter 12 Three-dimensional movement exercise for the Lower Limb, Foot and Ankle [torsion squat and dynamic calf]

The lower limb, foot and ankle

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The Foot and Ankle [Informative]

The foot typically suffers from its possessor spending much of the time on the front half with too much flexion forward. Like all the other parts of our body over use and misuse leads to compensations and repetitive strain injuries that in this case affect not only the foot, but the ankle, the knee, the hip, and the back as well.

Truly a foot problem is a whole body problem.

Being on the front of the foot limits your ability to fully dissipate force in three dimensions and, if this goes on for too long, it will significantly effect the mechanical advantages built into the joint and soft tissue interactions that are designed to allow the foot to work comfortably.

When we walk for a long time with the weight of the body bearing down on the front of the foot we overload the arch making it stretched and mobile. This pronation is called being flat-footed. Such a pronated arch stays flat all the time rather than just when it is supposed to during the heel strike to mid-stance portion of the walking cycle. When the arch is pronated you lose power at push off and absorb less of the shock of impact when you are walking or running. Over pronation also extends, inflames, stiffens the big toe and, in time, leads to a degenerative change such as bunions. Those of us who are experiencing the effects of a pronated arch attempt to gain back the power we have lost by turning our feet outward for more push at toe off. We also then attempt to regain shock absorption by bending our ankles, knees, hips and pelvis more.

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When we exercise this area by rising up and down on our toes we are practicing a one dimensional and non-functional exercise. In many ways our ignorance of how this area is designed to function and be utilized leads to tissue stress.

The Foot/Ankle Structure The multiple joint surfaces in the foot and ankle work together to create shock absorption. The forefoot is made of fingerlike toes whose long bones connect the toes to the mid foot. The mid foot is made up of small, flexible bones that are controlled by shape and overlapping soft tissue. The bones of the hind foot are larger with bigger joint surfaces that articulate with the tibia in the leg and the fibula in the ankle.

Numerous small bones make up four distinct areas of the foot and ankle. The forefoot is made up of the toes or phalanges and the long bones that are called the metatarsals. The mid foot is made up of five intermediate sized tarsal bones. The hind foot is made up of two large tarsal bones. Lastly the true ankle is made up of the tibia and fibula of the leg and the talus of the foot.

The joints of the foot are designed to carry a heavy load shared throughout the foot by continuous movement and a body balanced symmetrically above it. These joints absorb shock through movement far more than through compression. This synergistic movement of multiple small joints creates mobility in the foot/ankle.

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Wind up and spring back note: The foot/ankle is highly mobile in three dimensions relative to the knee immediately above.

Notable joint / soft tissue interactions of the foot and ankle are the strong, large and elastic Achilles tendon that attaches to the heel and is continuous with the plantar fascia.

These important shock absorbing and energy conserving soft tissues are often injured by repetitive strain.

[Practical Exercise] The Dynamic Calf Exercise

The first half of the Dynamic Calf Stretch

In this exercise you should hold on to a doorframe or counter top so that you are leaning into it for support. During the exercise pictured above the rear leg is slightly bent so that the other leg can be pivoted around it. The bent leg with the foot off the ground swings away from and behind the stationary leg. The swinging motion of the bent leg guides the stationary leg through an inward rotation. As the stationary leg rotates inward, 141 141

bend the knee and let the arch flatten to keep the heel on the ground. Try to keep the bending knee behind the toes, but be aware that this will require more bending at the ankle and at the hip and pelvis.

The second half of the Dynamic Calf Stretch

In the second part of this exercise the bent leg with the foot off the ground now swings across the front of the body. This swinging motion of the bent leg guides the stationary leg through rotation outward. As the stationary leg rotates outward, straighten the knee and let the arch come up. Keep the heel on the ground. There will be a straightening of the ankle, hip and pelvis as well.

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The dynamic calf as seen in the walking cycle

Leg starting to rotate in

Leg rotate in, arch flattening, knee bending

Leg starting to rotate out

Leg rotate out, arch lifting, knee straightening

The twisting calf stretch exercise matches the motion that occurs through the lower limbs during the normal walking cycle. It is important to evaluate and understand these complicated details because of what the body can hide from you.

The shape of the bones and joints of the foot permit the foot to change direction in the leg without creating the same change in direction in the foot. When used properly the foot can handle directional changes and still allow for energy transfer as the body accelerates or decelerates. The leg can turn in, but the foot stays straight and the arch of the foot flattens to allow for an inward rotation of the leg that allows shock absorption and deceleration. The leg can turn out while the foot stays straight and the arch comes up to allow for the outward rotation of the leg. At the same time it also creates a rigid lever out of the arch of the foot that provides more mechanical advantage for propulsion and acceleration of the body. This is the same motion that occurs in the dynamic calf exercise. It matches the anatomical movement of the walking cycle unlike many other exercises that merely allow a static stretching of the calf.

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TORSION SQUAT Whenever we bend or flex the movement comes primarily from our hips. We rarely rotate or do a side-bend and consequently we have poor awareness of the movement at the hips relative to the pelvis. By improving our awareness and working to improve the movement in the hips we can develop more effective symmetrical movement at the pelvis and ultimately the spine, knee and leg. Improved understanding and control of movement at the hip relative to the pelvis will increase symmetrical performance of the whole body and prevent injury.

The Torsion Squat is designed to improve our awareness and use of the muscles in the hips to a full 360 degrees. As we build this awareness we will become more conscious of how the thigh connects to the pelvis, and how the hip joint has both an internal and an external rotation. For maximum efficiency this internal and external rotation needs to be symmetrical between the two sides so that one side is not doing more work than the other.

This squat will help you gain control of the torsion in your body so that you are able to take advantage of a natural wind up and spring back of movement that the hips and pelvis are designed to provide. Without such three-dimensional exercise we are moving in a sub optimal fashion. Some of us get lucky and don’t interrupt this natural threedimensional movement. Others of us reinforce it naturally, but often, once we face the repetitive strain of our daily activities or we get injured, we don’t know how to recapture what we once did naturally.

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Many of us also don’t train in the way we ought. Too often we do a squat that only has just flexion and/or extension in it. What we need instead is to train for fully integrated three-dimensional movements with resistance from three independent planes of motion.

This exercise will allow you to reestablish torsion control over your body. If you are fighting some injury or soreness in your hips and pelvis this exercise will help uncover the hidden weaknesses that are preventing your full recovery. If you are under a chiropractor’s care this exercise will also speed your recovery from whatever is the reason you first sought his help.

The Exercise At first glance this exercise seems very different from the foot ankle concept of this chapter. But what is important here is that the torsion movement of the dynamic calf exercise is also contained within this torsion squat in a way that connects the foot and ankle to the motions of the knee, hip pelvis, and rest of the body. This whole body functional exercise once practiced can easily be done anywhere to remind the body of the details of this three-dimensional movement.

Hold your hands above your head and stand with your feet shoulder width apart. As you squat pull your navel toward your spine, tighten the pelvic floor and bend at the spine/pelvis joint while pulling your knees toward one another. As you bend at the hip pelvis tilt forward so your knees come together. Pay attention that you feel an equal pull on both sides of your hips/pelvis and that your knees are aligned equally with one another so that the flexion in both knees has an equal internal rotation and adduction. Your knees should align equally behind your toes (not forward or ahead of the other). They should come together at the body midline so that your legs do not bend unequally to the left or the right. If you’ve done this correctly your legs should rotate in and your arches should flatten.

As you come out of the squat the opposite should happen at each level: arch comes up as legs rotate outward, ankle, knee and hip straighten while leg and thigh come apart and rotate externally.

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Ideally this exercise should be repeated five times each hour to improve circulation to the tissues that are being held in one position for long periods of time. Hourly repetition will interrupt patterns that are created in the nervous system from the prolonged lower limb postures we endure. By frequently interrupting dysfunctional patterns new more beneficial ones can be formed so that they become comfortable, automatic, and the new normal.

The torsion squat exercise gets at the pronation and supination or the threedimensional movements of the lower limb and it gets specifically at the pronation and supination of the foot ankle from above. The dynamic calf exercise gets to pronation and supination in the foot and ankle from below.

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Awareness Builder for the dynamic calf and the torsion squat Key things to become aware of with this exercise are: Dynamic calf 

Notice that you are using the whole foot from heel to toe when walking and not just the forefoot and mid-foot

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How mobile the foot is in three dimensions – it bends not just up and down at the ankle but it rotates side to side and bends throughout its length and into the arches

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That the arch is meant to move up and down (it is not meant to stay arched.)

Torsion squat 

The internal rotation of the hip at the joint level

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The interconnection of movement between the hip, knee and foot with not just flexion and extension but with rotation and side bending as well

When you become aware of the torsion of combined three-dimensional movements in the lower limbs you will also become aware of a greater range of motion to not only absorb shock and dissipate energy but also to generate power at push off.

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Chapter 13 Functional Lower Limb Stretching [Informative]

The thigh and pelvis muscles help us balance, carry, propel, and decelerate, but they also hide weakness, tightness, and imbalance. These large muscles can also overwhelm our ability to move in balance because of their strength and our overuse of them. The problems that are generated by the size and force of these muscles are significant so it is best to identify these problems in order to work around them for greater functionality. The purpose of this chapter is to help you become aware of these large muscles in order to assess their ability to function freely and in balance with one another. These stretches are just an assessment tool rather than a strength builder. They will improve function by increasing circulation to these muscles and allow them to recover health, so in a sense, they are also a recovery tool but not a flexibility builder.

We will first work the hips and thighs in order to make the pelvis and the spine part of our movement. Eventually the goal will be to reverse this, to start from the abdomen and then the pelvis and then the thigh, but we need to build awareness first in the abdomen by stretching it and activating it. We are seldom aware of the three dimensional movement that is possible for the thigh and pelvis because walking limits our awareness of what goes on between the thigh and the pelvis. Since we rarely take a full stride we limit ourselves to a short quick step that leaves the work of carrying the body to the lower limbs. This short 149 149

quick step only requires a small flexion and extension of the thigh and pelvis. A long stride however involves the thigh, hip, pelvis, abdominals, and low back. It spreads out the physical demands that walking requires by making it a shared motion that is easier on all the tissues involved. At the end of a long stride the hip and pelvis take advantage of full three-dimensional movement that include rotation and side bending.

The following stretches will allow you to practice and develop the capabilities of the long stride. Once you begin practicing this step you will notice you have less resistance to it and you will find it is an easier way to move.

First I want to touch on the stride and break down the basics which you will hear again later on. It is good to begin to practice the stride before and after these exercises to: 1. integrate the mobility gained by these stretches into a functional every day movement like walking; and 2. it can also act as an outcome measure of progress as the muscles become more mobility and symmetrical the control over the stride improves.

Details of the stationary stride exercise:

Begin in a neutral standing position – on your heels, shoulders down, chin level with floor, string at the top of your head pulling your head up. Now while standing in place imitate one half of the walking cycle. To do this one leg has to remain stationary. Here goes: step forward with the right leg letting your heel strike the floor followed by the rest of your foot rolling forward along the outside edge across the toes and out to the large toe. Now

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swing that leg backward so that the foot comes down on the toes to settle on the heel just before it lifts off for its next swing forward. While you are stepping forward and back with your right leg your arms should swing in time with the walking cycle. The right arm should swing back as the right leg steps forward. The left arm should swing forward as the right leg swings back. Practice this forward and backward walking cycle through a series of steps till your feel slightly winded. After catching your breath switch legs and repeat the exercise with the one that was stationary now taking up the walking cycle.

The trick to make this a great exercise for the hip and pelvis is to engage the leg reach in a way that starts from the abdominals, moves into the hip and thigh, and continues down the leg. Your arm reach should also start from the abdominals, move into the shoulder, and continue down the arm and out the fingers. Done vigorously and with a full stretch your arms and legs should reach so far forward that the trunk and shoulders are engaged in a rotation and side bend. Done really well there should be just enough of a pause at the end of each stride so that other side is able to briefly relax. When both sides are moving in rhythm the stretch and reach is followed by a moment of relaxation that leads to a spring back followed by a stretch and reach in the opposite direction At times all of us move too fast and need to be more aware of how to do movements more slowly and under more control. I often have patients say “moving slowly hurts”. What they don’t realize is that they are using the momentum of quick movements to blow past areas in the movement that are weak or painful. This in place walking cycle can help you build awareness of how to fully engage all the parts of your body in the walking cycle. Many patients tell me that once they have learned to move with the rhythm of their hips, and shoulders, and arms that walking never felt so good. The pace and swing of walking in this way is energizing and invigorating. This exercise of walking in place is a good one to practice lightly and frequently throughout the day.

The goal is to swing equally forward and backward with the arm swing length equal to leg swing length. This symmetry will ultimately help performance and help take care of the joints of the whole body by improving balance.

Also be aware that the timing of the arm and leg swing typically needs even more practice on the non-dominant side because unless we have always walked symmetrically, right and left sides, we use the non-dominant side to support the body’s weight as we walk 151 151

like a pivot. As a pivot the non-dominant side is not involved as much in propulsion, so the leg swing on that side will be a shorter stride.

With a few days of consistent practice you will quickly be able to establish a rhythm and timing to your stationary stride. Practice for several days more in order to make the smoothness of the motion a part of your muscle memory and more automatic.

STRETCHES for the hip flexor; the gluteal musculature; the hamstrings; the quadriceps; the adductors and the abductors The following stretches for the lower limbs involve three dimensions of function through the muscles. They also incorporate movement interconnections with the upper body and core. In other words these stretches for the thigh and pelvis involve the whole body. They work the muscles in three dimensions and will help you get deep into the muscle with a stretch very similar to someone pulling on you to stretch you while you are relaxed. Practicing these stretches briefly and frequently throughout the day can help you gain more awareness and control of your stride.

To get at the “three dimensions of a particular muscles� you must get to the right side and left side as well as the top and bottom of that particular muscle. So in an exercise say for the quadriceps muscle in order to get to its superficial and deep fibers you would want to get at its right and left sides as well as its top and the bottom. Paying attention to all of the areas of the muscle with this stretch gives you the best chance to get circulation to all the muscle fibers of that particular muscle. Being thorough with this exercise is important for performance, recovery and longevity.

Each of the stretches that follow are designed to help you get at the superficial and the deep tissues on the right and left sides as well as the top and bottom of the muscle focused on.

[Practical Exercises] First the hip flexors: Place one of your feet onto a raised object such as a chair about shoulder width apart from your other foot. You can see from the photos below that by

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lifting your leg and foot onto a raised object you have stepped into a lunge position. As you lunge forward the front knee should stay behind the front ankle. As you straighten your back as part of the lunge your knee does not have to straighten completely. The back heel can come off the ground initially but with practice should remain on the ground. The forward lunge part of this exercise will isolate the lower part of the hip flexor muscle.

The second part of this exercise is to reach up to hold your arms parallel with your palms facing one another. Now lean your body backward as far as you can. This part of the exercise lets you effectively involve the upper half of the hip flexor.

In order to isolate the right and left halves of the hip flexor two additional stretches must be done. The first is to bend side to side while lunging forward. The second is to rotate from front to back. Both of these are done while maintaining the overhead reach.

The last part of the stretch effectively isolates the right and left parts of the hip flexors.

Having done this series with one leg, complete the exercise by repeating the same process of reaching into a back bend, leaning right to left, and rotating front to back with your other leg.

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The way to isolate the superficial fibers of a muscle is to perform a brief, light or less than full reach stretch. To get beyond the superficial fibers to the deep fibers you must do multiple repetitions of the stretch with a light warm-up exercise such as a squat in between repetitions. The warm up exercise will gradually activate more and more muscle fibers and allow them to more easily become involved in the stretch.

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Gluteal Stretches / Abductors The first part of this exercise gets at the lower half of the gluteal muscles. The basic position is to stand beside a chair with feet shoulder width apart. Cross one leg over the other and rest the outside of the ankle on the seat of the chair. Now execute a squat. When you squat with the one leg make sure to keep the knee behind the toes and slightly inside the ankles.

Now add an overhead reach with arms parallel and palms facing inward to involve the upper half of the gluteals. Squat as before. By adding a side bend or a rotation of the upper body to the squat you will effectively involve the right and left sides of the gluteal muscles you are working on.

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Performing several brief repetitions of this stretch with a ten to twenty second squat between repetitions allows you to gradually reach deeper fibers of the gluteal muscles.

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The stretch for the quadriceps involves the same movements as the squat – the backward lean, the side-to-side bend, and the back to front rotation. In this stretch however you will need a chair with a back on it and a cushion to place your knee on. Stand beside the chair and then bend a knee into the cushion so that your foot rests on the back of the chair.

Now bring your buttocks/hip back to meet the heel. This will stretch the lower part of the quadriceps from mid-thigh to the knee. Add an overhead reach and a backward lean of the upper body to involve the upper half of the quadriceps in the stretch.

Adding side bending movements and rotational movements of the upper body to each side involves the inside and outside of the quadriceps.

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Performing several brief repetitions of this stretch with a ten to twenty second squat between repetitions allows you to gradually reach deeper fibers of the quadriceps muscles with just a moderate effort.

Hamstrings: Start with feet and pelvis pointing straight ahead. Place the heel of the stretch leg on the seat of a chair or something of similar height. Bend forward at the hip without any forward rounding of the spine. At this point in the stretch you’ve only involved the midthigh down to the knee. By adding an overhead reach and then a side-to-side bend you will involve both upper and lower halves of the hamstring – the back of your thigh.

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Adding side bending movements and rotational movements of the upper body to each side involves the inside and outside of the hamstrings.

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Performing several brief repetitions of this stretch with a ten to twenty second squat between repetitions allows you to gradually reach deeper fibers of the quadriceps muscles with only a moderate effort.

Adductors: Start with both feet and pelvis pointing straight ahead. Place one leg up on a step or a chair to isolate the leg to be stretched. When you squat keep the body in the center of the stride. This squatting stretch only involves the lower half of the thigh until you add the overhead reach. This brings in the upper and lower half of the adductors into the stretch.

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Adding side bending movements and rotational movements of the upper body to each side involves the front and back of the adductors.

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Reach up and back while squatting to isolate the upper part of the adductor muscles.

Performing several brief repetitions of this stretch with a ten to twenty second squat between repetitions allows you to gradually reach deeper fibers of the quadriceps muscles with only a moderate effort.

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Awareness Builder Key things to become aware of with these exercises are: 

How the upper half of the thigh and pelvis muscles feel as you practice the overhead reach with bending and rotation movements. Typically when we exercise by stretching only the lower half of these muscles get stretched.



How the inside and outside portions of the thigh and pelvis muscles feel as a result side bending and rotating movements.

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Now it’s time to get the spine working with the limbs and the limbs working with the spine

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Chapter 14 Whole body integration exercise

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[Informative] After activating the thigh and pelvis with the previous exercises a functional stretch can be achieved with an exercise such as whole body circular series exercise. Since it is similar to a full stride it can stretch and help fatigued muscles recover throughout the whole body.

[Practical Exercise] The whole body circular series exercise: In the whole body circular series the round the clock stepping exercise you first learned is repeated with the addition of the overhead reach. In this variation you will hold a foam noodle or broomstick in your hands. Step straight ahead to twelve o’clock as before and turn your right foot inward. Hold that step and reach straight up with the noodle/broomstick. At the top of your reach rotate your arms, body, and pelvis in the opposite direction of your foot point. Leave your head, neck, and hips where they are and then bring your arms and foam/broom stick down to your waist and reach again, this time in the same direction as your foot point. Bring your hands back to your waist and step straight back to 6 o’clock. Turn your foot outward. Reach up and rotate your body again in the opposite direction of the new foot point position. Leave your head, neck, and hips where they are and then bring your arms back to your waist. Now reach up to rotate in the opposite direction to complete this first step. Follow this series as before to 8 then 2, 9 then 3, 10 then 4 o’clock following the same pattern. Switch to the other leg and foot.

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Whole body counter-rotations. These movements match and exaggerate those of the walking cycle.

Lead foot turns in and body rotates in the opposite direction with an over head reach [12 o’clock position]

Leave the head and hips where they are, then bring the arms down and then reach up in the opposite direction.

With the lead foot, step all the way down to the 6 o’clock position. Turn the foot outward and reach up in the opposite direction.

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Leave the head and hips where they are, then bring the arms down and then reach up in the opposite direction.

Above is 2 then the 8 o’clock positions with turns in the opposite direction.

Above are first the 3 then the 8 o’clock positions.

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Above are the 4 then the 10 o’clock positions.

Above are first the 6 then the 12 o’clock positions.

Above are first the 8 then the 2 o’clock positions.

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Above are first the 9 then the 3 o’clock positions.

Above are first the 10 then the 4 o’clock positions.

[Again, note that with all the circular series exercises there is a front and back to each stride. With the front portion of each stride the foot turns in. With the back half of each stride the foot turns out. The series goes first in a clockwise direction with the right foot leading while the left side pivots, and then it reverses itself in a counterclockwise direction with the left leg and foot leading and the right pivoting.]

The value of this whole body matrix rotation is that the counter rotations imitate the movements of the full stride. By learning to become comfortable with these movements you will be learning the balance and symmetry of using the pelvis as it was designed to move. In this practice as one leg goes forward the pelvis and lower back on that side go with it. At the same time as that leg goes forward the shoulder and arm on that side come back. When you turn the shoulder, upper back, and neck in the opposite rotational direction as the lower limb you create a spinal torsion that moves the pelvis and lower back 170 170

in counter rotation. As you move through the rotations your lower and upper back and your neck become more involved in these counter rotations. Exaggerating these stretches will allow these necessary movements to occur more easily so when you walk your walking will be more efficient and productive.

Awareness Builder Key things to become aware of with this exercise are: 

How the counter torsion or wind up is connected to the spring back of the spine



How movement in the spine is integrated with the reach and twist of the arm and leg reaching

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Chapter 15 – A review with a guide to whole body 3 dimensional self-assessment Here is where we have been. We began by dealing with the details of our neutral postures. We have worked on improving our awareness of our body position and movement, by becoming more aware of how our individual body parts work in three dimensions. We have begun to integrate those movements together while building our understanding that the body’s joint and soft tissues work together most efficiently and symmetrically in three dimensions. Along the way, if you have been doing the exercises I’ve outlined, you have built small improvements that are accumulating into huge benefits for your performance and for the prevention of stress that can produce continued pain and injury. I believe that those twelve exercises can transform the quality or your spinal awareness and physical health for a lifetime. I’ve listed them here so you can quickly refer to them when you need to and to help you recall the growth you have made along the way.

1. Hip / pelvis rotation series p.52-55 2. Lower back / pelvis /hip rotation series p.64-65 3. Three-dimensional core stretching p.73-74 4. Rib stretch series p.78-79 5. Upper back three-dimensional stretch series p.88-90 6. Neck three-dimensional stretch series p.97-98 7. Shoulder three-dimensional stretch series p.107-109 8. Three-dimensional forearm/wrist series p.117 9. Biceps/Triceps exercises p.119 10. Symmetrical squat with overhead reach series p.132 11. Twisting calf/torsion squat exercises p.141-2/p.147 12. Whole body torsion integration series p.166-170

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At this point we are becoming familiar with looking at the body as a whole instead of a bunch of individual parts. As part of this review I offer you this Self-Test of your whole body three-dimensional Symmetry with some helpful comments about what you may discover about the progress you have made. With these self-tests pay particular attention to all the parts of your own performance of them so that you might learn about improvements you have made and any hidden imbalances that still remain.

1. To test your right and left symmetry: throw a ball with your right arm and then your left arm. Then kick a ball first with your right leg and then your left. Are both sides equal or is one side easier and more productive than the other?

For an effective throw with each arm you must be able to initiate the arm pull back from the upper abdominals by pulling the ribs down to the pelvis. Then you must retract the shoulder blades to pull them toward the spine and down toward the pelvis. This sets you up to throw with your core, shoulder blade, and arm. Typically on the non-dominant, less coordinated side we throw by using the arm alone. Whether you are throwing from your right or left side for maximum effectiveness and efficiency the throw should start from the abs/core, followed by the chest, and then the arm. Similarly the leg swing forward should start from above the pelvis and you should feel a contraction/ tightening of the lower abdominals. This can easily be initiated by moving to an upright standing position with feet straight, toes up, and weight shifting backward to engage the abdominals that helps you resist the urge to fall backwards. The forward leg swing should progress from the abdominals to the front of the hip and then the front of the thigh. The back swing of the leg should start from the lower back, move down to the buttocks, and then into the back of the thigh. The knee and below will just about take care of itself.

2. To test your front and back symmetry: walk forward and then walk backward with a long controlled stride. As you do each walk become aware of your relative balance control forwards compared to backwards. Pay attention to the differences that may exist between going forward and going backward. Because 99% of our walking is forward our familiarity with it allows us to hide a lot of asymmetry. Walking backward will reveal that lack of front and back symmetry pretty quickly. When you test your forward symmetry pay attention to 173 173

whether or not you start from a neutral and upright position, and then as you begin to walk feel whether you are leaning forward as part of your walking cycle. If you stay in an upright neutral position and begin walking you should feel your abdominals engage as part of that movement. Of course, when you try walking backward you should also feel the abdominals engage.

When we try to walk backward, because it is a new way to move it will feel uncomfortable. This discomfort will lead us to do what we do when we move forward which is to lean forward to place the majority of our weight on our forefeet. We will then turn our feet outward, increase the bend in our ankles, knees, hips and spinal curves, and finally we will put it all together to move with the arms and the legs and not the core.

Ideally for walking backwards stand straight with your feet straight, toes up to shift your weight back, relax your back and buttocks, engage the stomach, your chin should be back, and you should feel the string on the top of your head pulling you lengthwise upwards. Now reach back with one leg beginning the movement in your lower back and buttocks. The back of the thigh should follow that while you reach forward with the same side arm from the abdominals, then the chest, then the arm; again move your arms back and forth side to side in the opposite direction of your leg movements; as you walk backwards continue to stand tall.

Here is the key - as you roll backward over your foot accentuate rolling over the heel and pull up the forefoot. This last move continues to prompt your body as a whole to lean backwards. It will help you to activate the muscles on the back half of the body to keep you from leaning forward to counterbalance falling backward.

I recommend that you become thoroughly familiar with walking forward with a full leg and arm swing before you attempt to walk backward in the seemingly complex way described above. Once you are walking forward in a way that involves the rotation of your hips and shoulders walking backward will be much easier because you will be more familiar with the rhythm of the walking cycle. The dual benefit of including a backwards walk as part of your exercise and training is that your back to front symmetry will improve as will your forward walking cycle.

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3. Top and Bottom Symmetry: Walk with your arms locked straight at your side. Now walk with your legs locked straight. Assess which one is easier. You may notice that they feel the same.

Walking with your legs locked straight accomplishes two things: first it helps you become aware of initiating your stride from your abdominals rather than below your pelvis at the hips or knees. It also allows you to realize the help a proper arm swing can give you with forward movement. You may notice that when the arms are involved your legs are not doing all the work.

For some of you walking with your arms straight may not feel any different than normal walking, but for others of you, you may be able to recognize an increased demand on the legs for balance or propulsion. Again a proper arm swing as discussed above and earlier in the book can aid balance, propulsion and deceleration by allowing the legs to relax and recover a little with each stride. Over time that recovery time will add up to a huge amount of saved energy.

By completing these short experiments you should now have a pretty good idea of the side dominance you carry around within your body. Retest these at the end of performing each of the exercises in this book for the first time and then again when you are comfortable performing all the exercises in this book. You will soon notice that these dominances begin to lessen as you bring your body into a more balanced threedimensional alignment.

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Chapter 16

Brushing Your Teeth for Your Spine Maintain 80 percent with 2 brief and frequent exercises Now that you know all the foundation exercises there are a couple of exercises that stand out from the rest. These two exercises will stimulate the body in similar ways to all the previous exercises. These can be done briefly and frequently enough to change the patterns of compensation in the nervous system brought about by our daily activities. It also is a bridge to a more effective walking cycle which is the optimal exercise for whole body stability.

Two Exercises that are like brushing your teeth for your spine 1. Brief side step, lower limb/spine counter rotation with foam noodle or broomstick behind the back:

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The same series above should be repeated with the opposite leg.1Repetition in each direction takes less than 10 seconds and I recommend do this series 1 time per hour.

2. Brief Overhead Reach Series:

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I repetition in each direction takes less than 10 seconds and I suggest doing 1set 1 time per hour. This can be performed without holding on to anything just be aware to keep the arms parallel throughout the exercise.

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Our progression: Along the way of discussing how to move symmetrically I’ve attempted to help you see there is a different way to think about walking that incorporates spinal movement and emphasizes the three-dimensional need for symmetry that our body’s design and construction demands. All those exercises have been building us toward this final exercise.

This exercise certainly needs the foundation we have built with the twelve exercises that form the foundation of this book. The good news is that this exercise is easier to implement than those twelve, you can take it with you wherever you go, it needs no equipment, and it is the most effective way to allow you to move in alignment without compensations for a long, long time. It’s called The 5 Way Reach.

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Chapter 17 Walking and the Five Way Reach.

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[Informative] The accumulated benefits in strength and performance of maintaining improvement in your walking cycle far outweigh the benefits of any workout program. The results of a workout program are always being integrated into a walking cycle and it is up to you to make sure they are beneficial and not just reenforcing an existing imbalance. That will lead to an injury. It is not simple to create a small retained improvement in your walking cycle but it is well worth the effort and, if you don’t put forth the effort, you are likely to pay for it later. Unfortunately the statement “if it is not broken don’t fix it” doesn’t work, it just means you are not ready to listen to your body yet. The rest of this chapter is about optimizing your awareness of your walking cycle.

The Five Way Reach is the exercise that pulls together all the pieces of what we have done from the neutral postures through each of the exercises built to bring your body into alignment. This final exercise requires an acute awareness and control of the details of moving forward and back with all four limbs and an elongated spine (the five elements of the reach). Practiced correctly and often it will make going out for a walk an effective tool for maintaining and redeveloping your body’s health and symmetry.

When I began this book I recounted injuries I learned to live with as a student athlete. These injuries were ultimately compounded by my lack of awareness of how my joints and soft tissues were affected by these injuries especially in relation to my spinal and fascia functions. As I learned and paid more attention to these functions I searched for an exercise that could tie these functions together efficiently. I wanted something that was not only easily doable and quick, but would require little or no equipment as well. I was

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searching for something that could be done anywhere and so repetitively that it could overcome the weak physical habits that were engrained into my muscles and nervous system.

In time I came to see that walking was the key exercise that would fulfill this wish list. I realized I was not thinking of the typical, everyday walk of getting from here to there.

I’m talking about a walk that is full of awareness of allowing each area of your body to contribute to the walking cycle. This is a walk in which the spine is fully utilized for propulsion and balance. It is integrated with the arms and legs swinging effectively as part of symmetrical movement. Walking such as this makes you aware that your limbs are contributing directly to your forward movement.

What I am talking about you may already recognize as the exercise you learned in Chapter 13 as the Stationary Stride Exercise. With the walking cycle and the five-way reach we just take that exercise out for a walk. Here’s a bit of a review to help you fine tune the elements of the Stationary Stride Exercise.

Remember that you must begin in the neutral standing posture so that the arm and leg swing starts with the active engagement of your abdominal muscles so that the leg swing can begin from your abdomen muscles. From there the movement goes from your pelvis through your thigh and on down the leg. At the same time the arm swing begins at the core moving from the shoulders through the upper arm and on out through the tips of the fingers.

As you step forward the opposite arm swings back and the rhythm of walking begins in place as you step forward and back on one leg with the arms swinging in time. With the

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reach of the arms and legs comes rotation, and with that rotation comes the connection of all the body parts you are designed to move with.

Please notice in the pictures the position of the hand in relation to the body in the forward and backward part of the arm swing. When the arm swing is forward the arm should rotate inward so the palm is facing back toward the body. When the arm swing is moving back the arm should rotate outward so the palm faces forward toward the body when the arm is behind you. By creating this rotation of your arm you are helping to guide shoulder blade movement and the shoulder to the core.

If your arm and hand are not moving in the fashion described above be aware that this indicates you are using your arms too little to make them an effective part of the spring back you are attempting to create in your walking cycle.

As the leg moves forward the thigh, leg and foot should rotate inward so that the foot is straight when the heel contacts the ground. This inward rotation will continue until mid-step, with the foot staying straight until the arch of the foot flattens or pronates. When the leg moves backward the thigh, leg and foot should rotate outward so that the foot is straight at heel lift-off. This outward rotation will continue until toe-off with the foot remaining straight until the arch of the foot returns or supinates. The correct rotation of the lower limb helps guide movement of the pelvis and improves the functional connection of the pelvis to the core.

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Walking like this is symmetrical because your arms and legs are moving forward and backward through an equal stretch and distance. Each leg swing forward is also equal in distance to the arm’s backward reach. Walking in this way can only be accomplished when it is initiated from the core that becomes engaged because the head is held up with the chin parallel to the ground.

So now let’s look more closely at the five elements of walking that includes the fiveway reach.

Reaches one and two include the forward and backward movement of the legs and arms.

Reaches three and four are created because as the legs work together in opposite directions they rotate the pelvis and lower part of the spine in one direction. And, as the arms work together with the “opposite direction reach” they rotate the upper back and lower neck in the opposite direction of the lower spine. If you were to compare the movement of the legs to the arms you would say that they basically rotate in the opposite direction of one another. Reaches three and four provide the right to left/side to side elements of three-dimensional symmetry.

Reach five involves the subtle elongation of the spine upward much as if there was a string in the center of your head pulling you lengthwise. It is like the keystone in an arch without it there would be no stability to the arch. This upward reach is the key to stability and performance in your walking and performance.

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This movement of reaching upward as your arms and legs are moving in their four directions straightens the spinal curves and stretches the para-spinal muscles so that the vertebrae are opened in a way that completes the tension in the system of your body’s muscles and joints. It allows for maximum wind up and spring back that is necessary for complete three-dimensional, symmetrical movement.

Without this last reach your walking will still be slouching, and you will still be performing sub-maximally. With it you are eliminating the slack from the system. The challenge is to maintain this upward reach while moving. Because this slack is subtle you have to train yourself to be aware enough to get at it, and then you must develop enough control to strengthen it and hold it as part of the complete and coordinated movement of the limbs and core as they stretch and spring back in a coordinated sequence.

When tension is put on the body’s soft tissues and their elastic fibers in all five directions the tissues are stretched to their maximum and complete elastic responsiveness is achieved. Stretching the arms and the legs and the head to their fullest potential causes the activation of muscle fibers and nerves without which there will not be optimal activation. Once you’ve brought these five components into your walking cycle you will realize that there is indeed a spring in your step.

The best way to build awareness of how to implement this 5 way reach is in the lower most rib on each side of your body. This lower rib is a key point that you should feel a twisting stretch at equally both sides. Reach with one leg forward and continue to reach until you feel the stretch up to the lower rib. Then reach with the same side upper limb through the shoulder blade until you feel the twisting stretch down to the same lower rib. This is made easier by doing the elongation of our spine reach at the same time. This reaching so that you feel the stretch to a common point on each side makes it easier to create a symmetrical stretch of all 4 limbs and at the same time involve the whole trunk, stretching from above and below.

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From the right leg reaching forward feel the stretch all the way up to the same side lowest rib. From the right arm reaching backward feel the stretch all the way down to the same side lowest rib. The double arrow shows that you experience a stretch all the way up and down when you reach to the point where you feel a stretch at the level of the lowest rib. Again this will be enhanced by the elongation of the spine.

Practicing the stationary stride also allows you to establish the kind of symmetrical balance you will need as you learn to walk in this way. Because this exercise is stationary it also takes away the need to shift back and forth between the right and left sides. I find when I challenge a patient to walk in this way they are quickly able to figure out the process of walking in place. The equal stretch front to back is an easy pattern for them to follow. However, the challenge comes when they try to take this work into the walking cycle itself. This requires increased awareness of the shifts in body position and movement the walking cycle requires.

I think this is particularly challenging because you are calling on your right and leftbrain to work with an integrated balance and rhythm. Truly, the shift from the right to the left-brain is the most challenging aspect of this because for the most part we don’t pay attention to how we accomplish these shifts. Once we slow down and pay attention to the mechanics of this exercise it takes a bit of time to do them with the stretch and tempo that it requires.

At five years of age when I started playing hockey it was an effort for me to stand on skates and not lean on my stick. Skating then was more like a walk. Each drill the coach gave me made something that seemed nearly impossible a little more doable. By the end of

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the season I was not only skating, but I was passing the puck and shooting at the goal as well. During that time I was not only learning new physical skills I was training my nervous system to respond to new stimuli and demands.

With each new skill that we learn in any kind of sport whether its hockey or dancing or swimming our progress as skilled participants grows as we practice and learn the moves that are required to be successful. Our awareness of how well we perform those moves determines how well we refine and perfect those moves.

Those kinds of changes in our physical functioning usually come as small mechanical tweaks that allow a new gain in performance. If you practice a particular skill enough to entrain it into your nervous system then you are able to apply that new capability to whatever task you can creatively combine with it. That is when performance progress is really accelerated. Examples of such small mechanical tweaks can be found in learned skills as: placing your opposite foot beside the soccer ball before you kick it to create more power with your shot; letting the football roll off the tips of your fingers as you throw it forward in order to manage its direction and distance with a spiral; bending your knees and elbows deeply and then using them together in a fluid movement to make a basketball shot with more power and control; keeping your arms in a full reach position when you make contact with the ball in golf or baseball.

These are the types of mechanical tips that change the way we move and perform in sports. As we learned them and practiced them we became more proficient because our muscles and our nervous system were learning through repetition and training the best and most efficient way to move to succeed in those new physical tasks.

The Five Way Reach is an invitation to take an approach similar to training for sports to the way we walk. It does us no good to have the attitude “this is the way I’ve always done it so this is the way that I must walk.� Just because this is the way we have always done something does not mean we are doing it correctly or to our best advantage. It is virtually impossible that we are walking properly because we are the victims of the repetition of our daily activities and the injuries we have sustained. Because we are unaware of the details of the walking cycle we may not be moving in the most efficient manner, and that lack of understanding limits our ability to recapture our natural threedimensional capabilities.

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The walking cycle and the Five Way Reach can retrain your body to move with symmetry and three-dimensional efficiency. As in all our previous exercises combining the five-way reach with the walking cycle briefly and frequently will soon create a new normal for the way that we move. Together they will train your nervous system to a new way of moving.

The five-way reach allows the whole body to continuously wind up and spring back.

With this reach the body will move more efficiently, maintain better balance in mechanically advantageous ways, and keep all tissues healthy by having them consistently utilized briefly, lightly, and synergistically. It also provides an effective cross training for the stress caused by poor postures in our daily activities whether it is from playing sports or sitting for long hours.

Awareness Builder about the Benefits of Walking with the Five Way Reach Let’s look at walking when the upper body - trunk and arms - become an active participant in it. Walking in this fashion involves an arm and leg swing that creates a twisting/torsion of the spine. To achieve this we must use a leg and arm swing that equally stretches the upper body forward and backward. This is a foreign concept for most of us but it provides several mechanical advantages that reduce repetitive strain throughout the body. When the upper body is an active participant during walking the mechanical advantages are: 1. The full torsion of the spine that is created by the swinging forward and back of opposing arms and legs allows the force of shock absorption to move up and down the spine rather than stopping it at the base of the spine.

2. The need for a forward lean is minimized because the upper body now contributes to the walking cycle and creates a better muscle activation that is balanced front to back in the trunk providing more core and spine stability.

3. Side dominance is more easily managed because the non-dominant upper limb becomes involved in the cycle. This reduces the spinal stress that is created when one side rotates more than the other.

4. The symmetrical arm swing enables us to achieve a balance during walking that comes from the entire body’s involvement in the movement rather than forcing balance 189 189

through muscular control in the legs. Think of walking symmetrically as opening a door by using the handle. It swings open easily and fluidly. Balancing the body from the knee down, on the other hand, is like opening the door by placing your hands near the hinges and then twisting your wrist to get the door to open. This is difficult because you have no mechanical advantage. In the same way walking without swinging your arms creates much more work for the legs.

5. Acceleration demands can now be balanced between the upper and lower limbs because an effective arm swing forward aids the lower body to toe off more easily by creating trunk torsion from above that is transferred to the legs.

6. The arms also help us manage to slow down. An effective arm swing backward helps swing the opposite leg forward for a better heel strike position. This heel strike position also decreases the stress on the lower limb joints when it is maintained consistently.

7. Shoulder health is better maintained with a complete arm swing. A more upright body position allows for an easier arm swing as well.

8. When the lower limbs are working symmetrically with the arms the body is better able to absorb the shock of impact because that shock is being transferred throughout the rest of the body. In addition to that benefit muscles that overlap the joints don’t have to stay contracted all the time and joints don’t have to bend as much. Thus the lower limbs can recover a little bit with every stride. Over time this makes a huge difference to the health of our limbs and tissues.

9. We develop more endurance because the energy in our bodies is better conserved due to the fact that we are now taking advantage of the spring back potential in the upper and lower body. The upper body springs include: the large connective tissue fascia over the back that connect the shoulder blades to the pelvis - the thoracolumbar fascia; the elastic abdominal muscles that connect the rib cage to the pelvis; the rotator cuff; the common tendon attachments of the forearm flexor and extensor muscles; and the multisegmented spine. All these connective tissues/springs work together with the alternating high and low mobility of the adjacent joint complexes to create a wind-up and spring back mechanism that conserves the energy of the body as it strikes the ground and turns it into energy that drives the body forward.

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10. When your whole body is working together you have the ability to maintain your momentum more effectively because there is less resistance created by the work of the legs being slowed or stopped at the base of the spine. When our body parts are all working together energy input from above keeps our momentum going forward. Once the system gets going there is more energy required to slow the body down than move it forward. This statement holds true for walking symmetrically in three-dimensional alignment or walking with a slouch that hangs the movement on the hips and forces the legs to plod forward carrying the weight of all that is above.

After reading about the benefits of walking in the fashion I’ve described I hope you see that challenging yourself to be more aware of how your body is designed to work is well worth it.

All it takes to start the change is to be aware that as you walk each step forward should be balanced by an equal stretch backward by the same side arm. Then relax that side as you swing your other leg forward and stretch back the same side arm. Each step forward and reach back should allow you to feel the spring of stepping in a rhythm that is balanced and coordinated. You will quickly notice how your shoulders and hips want to get into the dance as you practice this stepping forward with an equal pulling back on the opposite side.

There is more to the walking cycle and the Five Way Reach from a strengthening, and performance improvement stand point but the purpose of this book is only to increase your awareness and give you exercises that will build foundational strength, resiliency, and tissue health to enable you to successfully take the next step. Awareness is the first step and hopefully the increased mechanical health these exercises provide will create increased awareness in other areas of your life as well.

There are future books and videos to come to continue the improvement process. I teach three other core classes that strengthen the connection of your core to movement of your limbs. These classes are the Hip Core Connection, the Shoulder Core Connection, and the Three Dimensions of Walking. Each class is designed to help you continue to clear up any strength and control issues that may be hiding in your tissues and muscles that affect your performance and your energy levels.

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Enjoy your walking and keep your spine in mind!!!

1. Dynamic Chiropractic, August 18, 2000, Volume 18, Issue 18 : High Heeled Shoes and Musculoskeletal Problems.

Kim Christensen, DC,DACRB,CCSP Findings/conclusions: created restriction of subtalar pronation thus decreasing heel shock absorption capabilities and demanding more from joints proximal to the foot. Only heel heights greater than 5 cm significantly affected lower extremity mechanics and gait ( Ebbeling CJ, et al. Lower extremetiy mechanics and energy cost of walking in high-heeled shoes. JOSPT 1994; 19:190-196.

2. International Journal of Industrial Ergonomics, Volume 28, Issue 6, December 2001, pages 321-326 : Biomechanical effects of wearing high-heeled shoes, Chang-Min Lee, EunHee Jeong and Andris Freivalds. Findings: 200 young women and 3 heel heights ( 0, 4.5 and 8 cm), As heel heights increased, the trunk flexion angle decreased significantly ( counterbalancing gravity with anterior pelvic tilt and increasing lumbar lordosis. Also tibialis anterior and low back EMG’s and the vertical movement of the body center of mass increased significantly while walking with high heeled shoes.

3. Ebbeling CJ, et al. Lower extremetiy mechanics and energy cost of walking in high-heeled shoes. JOSPT 1994; 19:190-196. Findings: Analysis of the biomechanical data revealed that the ankle plantar flexion, knee flexion, vertical ground reaction force, and the maximum anteroposterior braking force increased as a function of heel height. Metabolically, heart rate and oxygen consumption also increased with heel height.

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4. The Effect of Limb-Length Discrepancy on Gait, The Journal of Bone and Joint Surgery. Kit M. Song, M.D., Suzanne E. Halliday, M.SC. and David G. Little, F.R.A.C.S., Dallas, Texas.

Findings: When a discrepancy was 5.5% of the length of the long extremity or more, more mechanical work was performed by the long extremity and there was a greater vertical displacement of the center of body mass. Clinically this degree of discrepancy was manifested by the use of toe-walking as a compensatory strategy. Children who had less of a discrepancy were able to use a combination of compensatory strategies to normalize the mechanical work performed by the lower extremities.

5. Reflex control of the spine and posture: a review of the literature from a chiropractic perspective. Mark W. Morningstar, Burl R. Pettibon, Heidi Schlappi, Mark Schlappi and Trevor V Ireland. Chiropractic and Osteopathy 2005,13:16 doi:10.1186/1746-1340-13-16.

Conclusion: Visual and vestibular input, as well as joint and soft tissue mechanoreceptors, are major players in the regulation of static upright posture. Each of these input sources detects and responds to specific types of postural stimulus and perturbations, and each region has specific pathways by which it communicates with other postural reflexes, as well as higher central nervous system reflex structures.

6. Effect of feet hyperpronation on pelvic alignment in the standing position. Gait and Posture, Volume 25, Issue 1, January 2007, pages 127-134. Sam Khamis and Ziva Yizhar.

Findings: suggest that the alignment of the lower extremity up to the pelvic girdle, can be altered, due to the forces acting on the foot. Interaction between the foot and pelvis occurs in a kinematic chain reaction manner. Hyperpronation lead to internal shank rotation, internal hip rotation and anterior pelvic tilt.

7. Movement, Stability, & Low Back Pain, “Vleeming, et. Al., Chap. 21, p256-257, esp fig 21.3.

The effective biomechanics of the foot, the three functional rockers of the foot during the gait cycle.

The whole body should work together to move: 8. Functional Soft Tissue Examination and Treatment by Manual Methods. Second edition, Warren I. Hammer. Chapter 8 The Foot: Hyperpronation and hypopronation , by Thomas C. Michaud.; Chapter 9 The Effect of Gait on Extremity Evaluation, by Keith A. Innes.

9. Gracovetsky S. The Spinal Engine. (Published as a separate text by the Spinex Corporation, 800 Rene LevesQueBlvd. West Montreal, Canada.) 1988.

10. Anatomy Trains, myofascial meridians for manual and movement therapists. Thomas W. Myers. Published by Churchill Livingston, 2001.

11. Jack Heggem. Running With The Whole Body, a 30-day program to running faster with less effort. Published by North Atlantic books in 1996.

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12. Thomas C. Michaud, Foot Orthoses and Other Forms of Conservative foot Care. Forces transmitted through the foot and body.

13. Carolyn Richardson, Gwendolen Jull, Paul Hodges, Julie Hides. Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain. ( pelvic stabilization exercise).

14 James A. Porterfield, Carl DeRosa. Mechanical Low Back Pain perspectives in functional anatomy. Lower extremity dysfunction effecting the low back.

15. James Russell Ebbets, D.C. Plantar Fascitis Overview anatomy, biomechanics and treatment.

16. Ambrosius, H. and M.P. Kondracki (1992). Plantar Fascitis. European Journal of Chiropractic 40:29-40.

17. Movement, Stability and Low Back Pain, the essential role of the pelvis. Edited by: Andry Vleeming, Vert Mooney, Thomas Dorman, Chris Snijders, Rob Stoeckart. Published 1997 by Churchill Livingston. Sections 2, 3, 4, and 5, chapter 25 of section 6.

18. Strength and Power in Sport, second edition edited by P. V. Komi. The encyclopaedia of sports medicine an IOC medical commission publication in collaboration with the international federation of sports medicine. Published by Blackwell 2003. Chapter 10 Stretch-Shortening Cycle, by Paavo V. Komi. Stretch reflex in muscle when they muscle is subjected to impact such as running walking and hopping. Pages 184 to 202.

19. Mechanical Neck Pain, perspectives in functional anatomy. James A. Porterfield and Carl DeRosa. Published by W. B. Saunders Company, 1995. Consequences of Forward head posture on the joints and muscles of the neck, jaw, shoulders and upper back. Chapters 1 to 3 pages 1 thru 80.

20. The Pelvic Girdle, an approach to the examination and treatment of the lumbo-pelvichip region, Second Edition. Diane Lee. Published by Churchill Livingstone 1999. Chapter 5 biomechanics of the lumbo-pelvic-hip complex, pages 43-73.

21. Diagnosis and Treatment of Movement Impairment Syndromes, by Shirley A. Sahrmann. Published by Mosby copyright 2002.

22. The spring-like function of the lumbar fascia in human walking. Adjo Zorn et al. Fascia Research, pg. 188. Elsevier, 2007.

23. Janda, Neurologic inhibition.

24. Sahrmann, scapulothoracic stability.

25. Gary Gray, Scapulothoracic Stability

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26. Hodges, 1999, Abdominal Canister.mechanism for torso energy transfer.

27. Norris,1999 QL and Respiration, mechanism for torso energy transfer.

28. Functional joint centration for joint stability and efficient energy transfer.

29. Breugger, posture relief, guide to the low stress neutral posture.

30. Lewitt 2008, Respiration and movement dysfunction, mechanisms for torso energy transfer.

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